Healthcare Provider Details

I. General information

NPI: 1598685059
Provider Name (Legal Business Name): PA VANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 GOLF RD
EAU CLAIRE WI
54701-8011
US

IV. Provider business mailing address

2720 GOLF RD
EAU CLAIRE WI
54701-8011
US

V. Phone/Fax

Practice location:
  • Phone: 715-318-0906
  • Fax: 715-800-2017
Mailing address:
  • Phone: 715-318-0906
  • Fax: 715-800-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4161-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: