Provider Demographics
NPI:1699339127
Name:ALICE PANG, O.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALICE PANG, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-602-0368
Mailing Address - Street 1:12642 OHMER WAY
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4826
Mailing Address - Country:US
Mailing Address - Phone:562-602-0368
Mailing Address - Fax:888-965-0574
Practice Address - Street 1:141 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2419
Practice Address - Country:US
Practice Address - Phone:562-602-0368
Practice Address - Fax:888-965-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629233754OtherNPI