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General NPI Number Information
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NPI Number | 1699339127
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Entity Type | Organization
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Legal Business Name | ALICE PANG, O.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 141 LAKEWOOD CENTER MALL
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City | LAKEWOOD
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State | CA
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Zip | 90712-2419
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Country | US
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Telephone | 562-602-0368
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Fax | 888-965-0574
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Provider Business Mailing Address
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Address Line | 12642 OHMER WAY
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4826
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Country | US
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Telephone | 562-602-0368
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Fax | 888-965-0574
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Authorized Official
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Title or Position | CEO/OPTOMETRIST
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Name | DR. ALICE PANG
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Credential | OD
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Telephone | 562-602-0368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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