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General NPI Number Information
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NPI Number | 1124012802
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALIST OF THE FINGER LAKES
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2300 BUFFALO RD BLDG 700B
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City | ROCHESTER
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State | NY
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Zip | 14624-1360
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Country | US
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Telephone | 585-254-2260
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Fax | 585-254-4035
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Provider Business Mailing Address
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Address Line | 2300 BUFFALO RD BLDG 700B
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City | ROCHESTER
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State | NY
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Zip | 14624-1360
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Country | US
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Telephone | 585-254-2260
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Fax | 585-254-4035
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHI-HWA WILLIAM CHANG
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Credential | MD
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Telephone | 585-254-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 199170
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License Number State | NY
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