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General NPI Number Information
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NPI Number | 1770439630
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Entity Type | Organization
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Legal Business Name | MICAH V PAN., O.D.
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 15942 LOS SERRANOS COUNTRY CLUB DR STE A
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City | CHINO HILLS
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State | CA
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Zip | 91709-4531
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Country | US
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Telephone | 909-606-9943
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Fax | 909-606-9118
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Provider Business Mailing Address
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Address Line | 15942 LOS SERRANOS COUNTRY CLUB DR STE A
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City | CHINO HILLS
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State | CA
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Zip | 91709-4531
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Country | US
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Telephone | 909-606-9943
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Fax | 909-606-9118
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Authorized Official
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Title or Position | CEO
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Name | LINDA H PAN
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Credential |
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Telephone | 909-472-7959
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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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