Healthcare Provider Details

I. General information

NPI: 1083007140
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: 03/13/2015
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N BROADWAY
LOS ANGELES CA
90031-2219
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 323-221-6186
  • Fax: 323-221-0738
Mailing address:
  • Phone: 800-898-2020
  • Fax: 844-897-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberA69909
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA69909
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TOM S CHANG
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 626-568-8838