Active NPI
Tracy Wang, O.D.
- Optometrist
- Palo Alto, CA
National Provider Identifier
1750744165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 33490
- Practice address
- 3801 Miranda Ave
112/Optom
Palo Alto, CA 94304-1207 - Phone
- (650) 493-5000
- NPI assigned
- Apr 2, 2016
- Last updated
- Aug 28, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | 33490 | CA | Primary |
Addresses
Primary practice location
3801 Miranda Ave
112/Optom
Palo Alto, CA 94304-1207
Mailing address
3846 Denise LN
Castro Valley, CA 94546-1208
Phone (510) 407-4957
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33490 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503878400000",
"number": "1750744165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3846 DENISE LN",
"city": "CASTRO VALLEY",
"state": "CA",
"postal_code": "945461208",
"telephone_number": "510-407-4957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3801 MIRANDA AVE",
"address_2": "112/OPTOM",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041207",
"telephone_number": "650-493-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "TRACY",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-02",
"last_updated": "2017-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "33490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.