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General NPI Number Information
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NPI Number | 1821110883
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Entity Type | Organization
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Legal Business Name | CHI CHANG OD, INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18805 STATE ROUTE 2 STE A
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City | MONROE
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State | WA
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Zip | 98272-1438
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Country | US
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Telephone | 360-805-9323
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Fax | 360-805-0467
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Provider Business Mailing Address
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Address Line | 3507 149TH PL SE
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City | SNOHOMISH
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State | WA
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Zip | 98296-6984
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Country | US
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Telephone | 206-769-1918
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Fax | 360-805-0467
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHI CHANG
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Credential | OD
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Telephone | 206-769-1918
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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 | 3812TX
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License Number State | WA
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