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General NPI Number Information
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NPI Number | 1740316041
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Entity Type | Individual
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Provider Name | CHI CHANG OD
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 3333 BRISTOL ST
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City | COSTA MESA
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State | CA
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Zip | 92626-1873
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Country | US
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Telephone | 714-754-1869
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Fax | 714-754-1871
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Provider Business Mailing Address
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Address Line | 1609 S VARNA ST
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City | ANAHEIM
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State | CA
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Zip | 92804-6128
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Country | US
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Telephone | 206-769-1918
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Fax | 909-646-7097
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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 | 41376
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3812
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14376
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License Number State | CA
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