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General NPI Number Information
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NPI Number | 1801989322
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Entity Type | Organization
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Legal Business Name | COOPER - PANG EYE CLINIC, P.A.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 561 MEDICAL DRIVE
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City | CLARKSDALE
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State | MS
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Zip | 38614
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Country | US
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Telephone | 662-627-5256
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Fax |
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Provider Business Mailing Address
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Address Line | 561 MEDICAL DRIVE
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City | CLARKSDALE
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State | MS
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Zip | 38614
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Country | US
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Telephone | 662-627-5256
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. VICTOR PANG
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Credential |
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Telephone | 662-627-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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