Individual
DR. CHIH JEN WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1560 W US HIGHWAY 50, O FALLON, IL 62269-1619
(618) 397-6575
(800) 432-6004
Mailing address
211 E BROADWAY, ALTON, IL 62002-6220
(800) 407-2696
(800) 432-6004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009615
IL
152W00000X
Optometrist
2004001752
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009615
—
IL
01
—
P00403017
RR MEDICARE
IL
Enumeration date
05/12/2006
Last updated
02/14/2014
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