Wang, Jacquelyn
Wang, Jacquelyn is an individual health care provider with primary practice located at 4175 S Grand Canyon Dr Ste 105 , Las Vegas NV 89147-7155. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Wang, Jacquelyn can be contacted via phone (702) 912-4254.Contact Information
Primary practice address
4175 S Grand Canyon Dr Ste 105
Las Vegas NV 89147-7155
Phone: (702) 912-4254
Fax: (702) 847-7624
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 15226TLG | California |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1124 | Nevada |
Profile Details
| NPI number | 1215319496 |
|---|---|
| LBN Legal business name | Wang, Jacquelyn |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2015 |
| Last updated | Jan 5th, 2026 - about 9 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215319496 | NPPES |
| California | MEDICAID | 1215319496 |
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