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General NPI Number Information
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NPI Number | 1083007140
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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 | 03/13/2015
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2400 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-2219
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Country | US
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Telephone | 323-221-6186
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Fax | 323-221-0738
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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 | 844-897-3788
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. TOM S CHANG
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Credential | MD
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Telephone | 626-568-8838
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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 | A69909
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A69909
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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