Healthcare Provider Details

I. General information

NPI: 1720679558
Provider Name (Legal Business Name): AMY CHANG OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 N 79TH ST STE 101
NIWOT CO
80503-8978
US

IV. Provider business mailing address

6800 N 79TH ST STE 101
NIWOT CO
80503-8978
US

V. Phone/Fax

Practice location:
  • Phone: 303-652-0505
  • Fax: 303-652-0606
Mailing address:
  • Phone: 303-652-0505
  • Fax: 303-652-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY CHANG
Title or Position: OWNER
Credential: OD
Phone: 303-652-0505