Healthcare Provider Details

I. General information

NPI: 1952664914
Provider Name (Legal Business Name): STEPHEN CHANG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CIRCLE DR
SALINAS CA
93905-2150
US

IV. Provider business mailing address

1436 20TH ST UNIT #4
SANTA MONICA CA
90404-2956
US

V. Phone/Fax

Practice location:
  • Phone: 831-757-8689
  • Fax: 831-757-1597
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: