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General NPI Number Information
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NPI Number | 1063009637
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Entity Type | Organization
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Legal Business Name | RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 81893 DOCTOR CARREON BLVD STE 2
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City | INDIO
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State | CA
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Zip | 92201-5592
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Country | US
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Telephone | 760-342-9991
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Fax | 844-897-3788
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Provider Business Mailing Address
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Address Line | 288 N SANTA ANITA AVE STE 402
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City | ARCADIA
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State | CA
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Zip | 91006-3183
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Country | US
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Telephone | 800-898-2020
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | TOM S CHANG
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Credential | MD
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Telephone | 800-898-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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