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General NPI Number Information
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NPI Number | 1679881106
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Entity Type | Organization
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Legal Business Name | DOCTOR BOGARD CHANG OPTOMETRY INC
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 1711 W TEMPLE ST FL 7
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City | LOS ANGELES
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State | CA
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Zip | 90026-5421
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Country | US
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Telephone | 213-413-8213
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 W TEMPLE ST STE 7136
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City | LOS ANGELES
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State | CA
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Zip | 90026-7336
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Country | US
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Telephone | 213-413-8213
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Fax | 213-413-2879
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOGARD CHANG
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Credential | OD
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Telephone | 213-413-8213
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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 | 11253TPL
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License Number State | CA
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