MEDICARE: DR. ADA P NG 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	2245	CO

General Provider Information

NPI Number	:	1831252055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADA P NG O.D.

Provider Business Mailing Address
First Line	:	727 BEAR PAW LN S
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906
Country	:	US
Telephone Number	:	719-290-6746
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 BARNES RD.
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922
Country	:	US
Telephone Number	:	719-591-0401
Fax Number	:	719-591-3014

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/26/2008

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