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General NPI Number Information
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NPI Number | 1427212497
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Entity Type | Individual
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Provider Name | TINA TING-LI CHANG O.D., M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 596 BOAR CIR
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City | FREMONT
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State | CA
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Zip | 94539-6042
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Country | US
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Telephone | 510-579-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 596 BOAR CIR
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City | FREMONT
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State | CA
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Zip | 94539-6042
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Country | US
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Telephone | 510-579-6365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV007274
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | OPT 13689 TPA
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 1645
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License Number State | AZ
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