Healthcare Provider Details

I. General information

NPI: 1225560725
Provider Name (Legal Business Name): TRILOGY EYE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 ARDEN AVE 430
GLENDALE CA
91203-1130
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 818-539-8016
  • Fax: 818-351-3657
Mailing address:
  • Phone: 626-269-5357
  • Fax: 626-574-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCA

VIII. Authorized Official

Name: TOM S CHANG
Title or Position: FOUNDER
Credential: MD
Phone: 626-568-8838