Provider Demographics
NPI:1912748575
Name:VANG, LINDA PAJNTSHA (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:PAJNTSHA
Last Name:VANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3637 SONOMA AVE APT 144
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5436
Mailing Address - Country:US
Mailing Address - Phone:559-367-6896
Mailing Address - Fax:
Practice Address - Street 1:2655 CLEVELAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2779
Practice Address - Country:US
Practice Address - Phone:707-842-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist