Healthcare Provider Details

I. General information

NPI: 1063009637
Provider Name (Legal Business Name): RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81893 DOCTOR CARREON BLVD STE 2
INDIO CA
92201-5592
US

IV. Provider business mailing address

288 N SANTA ANITA AVE STE 402
ARCADIA CA
91006-3183
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-9991
  • Fax: 844-897-3788
Mailing address:
  • Phone: 800-898-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM S CHANG
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 800-898-2020