Healthcare Provider Details

I. General information

NPI: 1134051360
Provider Name (Legal Business Name): DIANA CHANG OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 COORS BYPASS NW
ALBUQUERQUE NM
87114-3930
US

IV. Provider business mailing address

6400 GLENDALE AVE NE 2128
ALBUQUERQUE NM
87113
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-0738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIANA CHANG
Title or Position: OWNER
Credential:
Phone: 505-569-1146