MEDICARE: MATTY CHANG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12280T	CA

General Provider Information

NPI Number	:	1770502296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTY CHANG O.D.

Provider Business Mailing Address
First Line	:	311 N TUSTIN ST STE B
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-7776
Country	:	US
Telephone Number	:	714-997-7500
Fax Number	:	714-997-4864

Provider Business Practice Location Address
First Line	:	311 N TUSTIN ST STE B
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-7776
Country	:	US
Telephone Number	:	714-997-7500
Fax Number	:	714-997-4864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/21/2015

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Directions to “ MATTY CHANG O.D.” Practice Location

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