Healthcare Provider Details

I. General information

NPI: 1558278390
Provider Name (Legal Business Name): ANDREA CHANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 STEVENSON ST # 2-4
SAN FRANCISCO CA
94105-2936
US

IV. Provider business mailing address

55 STEVENSON ST # 2-4
SAN FRANCISCO CA
94105-2936
US

V. Phone/Fax

Practice location:
  • Phone: 415-981-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: