=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447432810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBERT PANG OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2007
-----------------------------------------------------
Last Update Date | 10/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6209 CHAPEL HILL BLVD SUITE 100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-0707
-----------------------------------------------------
Fax | 972-378-3865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6209 CHAPEL HILL BLVD SUITE 100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-0707
-----------------------------------------------------
Fax | 972-378-3865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR
-----------------------------------------------------
Name | DR. ALBERT W PANG
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 972-378-0707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 152W00000X
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------