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General NPI Number Information
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NPI Number | 1871016808
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Entity Type | Organization
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Legal Business Name | RETINA INSTITUTE OF CALIFORNIA
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DR # 2-3
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 619-697-4600
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Fax | 619-445-5526
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Provider Business Mailing Address
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Address Line | 100 E CALIFORNIA BLVD
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City | PASADENA
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State | CA
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Zip | 91105-3205
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Country | US
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Telephone | 626-568-8838
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Fax | 626-583-8838
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Authorized Official
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Title or Position | FOUNDER
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Name | TOM S CHANG
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Credential | MD
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Telephone | 800-898-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | CA
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