Healthcare Provider Details

I. General information

NPI: 1992934541
Provider Name (Legal Business Name): LINDA PANG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST SUITE 2
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E 2ND ST SUITE 2
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-3899
  • Fax: 909-469-8640
Mailing address:
  • Phone: 909-469-8773
  • Fax: 909-469-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number14546TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14546TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: