MEDICARE: DR. VANESSA LOO CHANG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2733T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2733T	OTHER	TX	TX OPTOMETRY LISCENSE

General Provider Information

NPI Number	:	1386869451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA LOO CHANG O.D.

Provider Business Mailing Address
First Line	:	318 W NOLANA AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2528
Country	:	US
Telephone Number	:	956-664-0444
Fax Number	:	956-664-0446

Provider Business Practice Location Address
First Line	:	318 W NOLANA AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2528
Country	:	US
Telephone Number	:	956-664-0444
Fax Number	:	956-664-0446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	05/16/2012

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