=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326338658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIA CHANG, OD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2011
-----------------------------------------------------
Last Update Date | 06/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 HENSHAW ST
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-903-3538
-----------------------------------------------------
Fax | 617-903-3547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 HENSHAW ST
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-903-3538
-----------------------------------------------------
Fax | 617-903-3547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HUICHU JULIA CHANG
-----------------------------------------------------
Credential | OD, PHD
-----------------------------------------------------
Telephone | 617-903-3538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4569
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------