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General NPI Number Information
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NPI Number | 1861544975
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Entity Type | Organization
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Legal Business Name | DR PATRICIA CHANG OPTOMETRIC GROUP INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 305 BROADWAY
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City | MILLBRAE
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State | CA
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Zip | 94030-2509
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Country | US
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Telephone | 650-697-2475
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Fax | 650-692-7154
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Provider Business Mailing Address
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Address Line | 305 BROADWAY
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City | MILLBRAE
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State | CA
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Zip | 94030-2509
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Country | US
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Telephone | 650-697-2475
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Fax | 650-692-7154
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA CHANG
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Credential | O.D.
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Telephone | 650-697-2475
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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 | 1080
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License Number State | CA
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