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General NPI Number Information
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NPI Number | 1811192289
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Entity Type | Individual
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Provider Name | CHEA-YO CHANG O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 4601 DALE RD 3RD FLOOR, ROOM 3A9 (EYE CARE SERVICES)
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City | MODESTO
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State | CA
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Zip | 95356-9718
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Country | US
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Telephone | 209-735-3133
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Fax | 209-735-3155
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Provider Business Mailing Address
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Address Line | PO BOX 2626
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City | TURLOCK
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State | CA
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Zip | 95381-2626
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Country | US
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Telephone |
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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 | ODP 100-111
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License Number State | ID
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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 | OPT 13626
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License Number State | CA
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