Provider Demographics
NPI:1770787392
Name:VANESSA LOO CHANG & DENNIS M CHANG OD PTR
Entity type:Organization
Organization Name:VANESSA LOO CHANG & DENNIS M CHANG OD PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-664-0444
Mailing Address - Street 1:318 W NOLANA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2528
Mailing Address - Country:US
Mailing Address - Phone:956-664-0444
Mailing Address - Fax:956-664-0446
Practice Address - Street 1:318 W NOLANA
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2528
Practice Address - Country:US
Practice Address - Phone:956-664-0444
Practice Address - Fax:956-664-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082259501Medicaid
TX00E43GMedicare ID - Type UnspecifiedPROVDER ID