Basic Information
| Provider Information | |||||||||
| NPI: | 1447432810 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALBERT PANG OD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6209 CHAPEL HILL BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750931610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723780707 | ||||||||
| FaxNumber: | 9723783865 | ||||||||
| Practice Location | |||||||||
| Address1: | 6209 CHAPEL HILL BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750931610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723780707 | ||||||||
| FaxNumber: | 9723783865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | PANG | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | DR | ||||||||
| AuthorizedOfficialTelephone: | 9723780707 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 152W00000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 093451502 | 05 | TX | MEDICAID |