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General NPI Number Information
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NPI Number | 1487887576
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Entity Type | Organization
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Legal Business Name | MATTY CHANG OD INC
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 630 N ROSE DR
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City | PLACENTIA
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State | CA
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Zip | 92870-7513
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Country | US
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Telephone | 714-524-6688
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Fax | 714-524-7678
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Provider Business Mailing Address
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Address Line | 630 N ROSE DR
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City | PLACENTIA
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State | CA
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Zip | 92870-7513
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Country | US
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Telephone | 714-524-6688
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Fax | 714-524-7678
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MATTY CHANG
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Credential | O.D
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Telephone | 714-524-6688
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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 | 12280T
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License Number State | CA
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