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General NPI Number Information
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NPI Number | 1013453877
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Entity Type | Organization
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Legal Business Name | GRACE CHANG, OD PC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 6575N FRONTIER DR
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1415
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Country | US
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Telephone | 703-971-7722
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Fax | 703-971-1724
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Provider Business Mailing Address
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Address Line | 6575N FRONTIER DR
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1415
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Country | US
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Telephone | 703-971-7722
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Fax | 703-971-1724
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. GRACE CHANG
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Credential |
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Telephone | 703-971-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618002188
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License Number State | VA
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