Provider Demographics
NPI:1881797819
Name:PANGAN, R. DALE (OD)
Entity type:Individual
Prefix:
First Name:R.
Middle Name:DALE
Last Name:PANGAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 BUTTERFIELD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3182
Mailing Address - Country:US
Mailing Address - Phone:972-315-9306
Mailing Address - Fax:972-315-9306
Practice Address - Street 1:851 STATE HIGHWAY 121 BYP
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4158
Practice Address - Country:US
Practice Address - Phone:972-315-9306
Practice Address - Fax:972-315-9306
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4319T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E68UMedicare PIN