MEDICARE: DR. JULIE CHANG, O D, INC

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	401	NV

General Provider Information

NPI Number	:	1811171283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JULIE CHANG, O D, INC

Provider Business Mailing Address
First Line	:	4388 E CRAIG RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1962
Country	:	US
Telephone Number	:	702-643-9191
Fax Number	:	702-643-8191

Provider Business Practice Location Address
First Line	:	4388 E CRAIG RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1962
Country	:	US
Telephone Number	:	702-643-9191
Fax Number	:	702-643-8191

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIE S PARK-CHANG
Credential	:	O.D.
Telephone Number	:	702-643-9191

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	08/21/2023

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