MEDICARE: DR. ALBERT WAIKEUNG PANG OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3672TG	TX

General Provider Information

NPI Number	:	1306823158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT WAIKEUNG PANG OD

Provider Business Mailing Address
First Line	:	6209 CHAPEL HILL BLVD
Second Line	:	STE 100
City	:	PLANO
State	:	TX
Zip	:	75093-6392
Country	:	US
Telephone Number	:	972-250-2733
Fax Number	:	972-248-8072

Provider Business Practice Location Address
First Line	:	6209 CHAPEL HILL BLVD
Second Line	:	STE 100
City	:	PLANO
State	:	TX
Zip	:	75093-6392
Country	:	US
Telephone Number	:	972-250-2733
Fax Number	:	972-248-8072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	10/05/2012

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