Healthcare Provider Details

I. General information

NPI: 1194185694
Provider Name (Legal Business Name): RETINA INSTITUTE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 626-269-5348
  • Fax: 265-838-8386
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 TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA69909
License Number StateCA

VIII. Authorized Official

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