Provider Demographics
NPI:1760895023
Name:VANG, PAULA (OD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 STOCKTON BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2374
Mailing Address - Country:US
Mailing Address - Phone:916-573-2020
Mailing Address - Fax:916-573-2255
Practice Address - Street 1:6833 STOCKTON BLVD STE 440
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2374
Practice Address - Country:US
Practice Address - Phone:916-573-2020
Practice Address - Fax:916-573-2255
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist