{
"NPI": [
{
"NPI": "1053584474",
"EntityType": "Organization",
"IsOrgSubpart": "Y",
"ParentOrgLBN": "TRILOGY EYE MEDICAL GROUP, INC",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "5565 GROSSMONT CENTER DR STE 551",
"PracticeLocationAddressCityName": "LA MESA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91942-3078",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-465-2020",
"PracticeLocationAddressFaxNumber": "619-698-1189",
"EnumerationDate": "04/07/2008",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-269-5311",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1114205432",
"EntityType": "Organization",
"IsOrgSubpart": "Y",
"ParentOrgLBN": "TRILOGY EYE MEDICAL GROUP INC.",
"OrgName": "TRILOGY EYE MEDICAL GROUP INC",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E. CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "100 E CALIFORNIA BLVD",
"PracticeLocationAddressCityName": "PASADENA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91105-3205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-568-8838",
"PracticeLocationAddressFaxNumber": "626-796-7657",
"EnumerationDate": "08/03/2011",
"LastUpdateDate": "08/23/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-269-5311",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "207W00000X",
"Taxonomy2": "Ophthalmology Physician",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207WX0107X",
"Taxonomy3": "Retina Specialist (Ophthalmology) Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1235570607",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-269-5371",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "207 S SANTA ANITA AVE",
"SecondLinePracticeLocationAddress": "SUITE P-25",
"PracticeLocationAddressCityName": "SAN GABRIEL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91776-1146",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-269-5355",
"PracticeLocationAddressFaxNumber": "626-284-8448",
"EnumerationDate": "07/12/2013",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-289-2223",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "NULL",
"PrimaryTaxonomySwitch3": "N",
"TaxonomyCode4": "207WX0107X",
"Taxonomy4": "Retina Specialist (Ophthalmology) Physician",
"LicenseNumberStateCode4": "CA",
"PrimaryTaxonomySwitch4": "N",
"OtherIdentifier1": "FQ161B",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(N)",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(S)",
"OtherIdentifier3": "1114205432",
"OtherIdentifierType3": "MEDICAID",
"OtherIdentifierState3": "CA",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1982045449",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-574-0020",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "17833 COLIMA RD",
"PracticeLocationAddressCityName": "CITY OF INDUSTRY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91748-1729",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-965-8895",
"PracticeLocationAddressFaxNumber": "626-965-8876",
"EnumerationDate": "07/12/2013",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-289-2223",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "NULL",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "NULL",
"PrimaryTaxonomySwitch3": "Y",
"TaxonomyCode4": "207WX0107X",
"Taxonomy4": "Retina Specialist (Ophthalmology) Physician",
"LicenseNumberStateCode4": "CA",
"PrimaryTaxonomySwitch4": "N",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(S)",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1588099097",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-574-0020",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "2400 N BROADWAY",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90031-2219",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "323-221-8000",
"PracticeLocationAddressFaxNumber": "323-221-0738",
"EnumerationDate": "09/04/2013",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "800-898-2020",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "NULL",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "NULL",
"PrimaryTaxonomySwitch3": "Y",
"TaxonomyCode4": "207WX0107X",
"Taxonomy4": "Retina Specialist (Ophthalmology) Physician",
"LicenseNumberStateCode4": "NULL",
"PrimaryTaxonomySwitch4": "N",
"OtherIdentifier1": "FQ161B",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(N)",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(S)",
"OtherIdentifier3": "1114205432",
"OtherIdentifierType3": "MEDICAID",
"OtherIdentifierState3": "CA",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1366850471",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "4413 LA JOLLA VILLAGE DR STE P-1",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92122-1264",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-320-0075",
"PracticeLocationAddressFaxNumber": "858-320-0053",
"EnumerationDate": "08/01/2014",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR (S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR (N)",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1558754762",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRIOLOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "116 N PLAZA ST",
"PracticeLocationAddressCityName": "BRAWLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92227-2426",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-344-4330",
"PracticeLocationAddressFaxNumber": "760-344-6956",
"EnumerationDate": "03/12/2015",
"LastUpdateDate": "09/13/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumber1": "A69909",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumber2": "A69909",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161B",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(N)",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(S)",
"OtherIdentifier3": "1114205432",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "GROUP NPI",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1184017261",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "1420 OCOTILLO DR",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "EL CENTRO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92243-4254",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-353-1140",
"PracticeLocationAddressFaxNumber": "760-353-1153",
"EnumerationDate": "03/12/2015",
"LastUpdateDate": "09/18/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumber1": "A69909",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumber2": "A69909",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1851784011",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "44815 FIG AVE",
"PracticeLocationAddressCityName": "LANCASTER",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93534-3144",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "661-206-9753",
"PracticeLocationAddressFaxNumber": "661-941-4302",
"EnumerationDate": "03/12/2015",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumber1": "A69909",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumber2": "A69909",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161B",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(N)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161A",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(S)",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1205229382",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "14642 NEWPORT AVE",
"SecondLinePracticeLocationAddress": "SUITE 210",
"PracticeLocationAddressCityName": "TUSTIN",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92780-6057",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-884-3957",
"PracticeLocationAddressFaxNumber": "714-884-3458",
"EnumerationDate": "03/12/2015",
"LastUpdateDate": "09/18/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumber1": "A69909",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumber2": "A69909",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1033502273",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "2240 N HARBOR BLVD",
"SecondLinePracticeLocationAddress": "210",
"PracticeLocationAddressCityName": "FULLERTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92835-2631",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-278-1834",
"PracticeLocationAddressFaxNumber": "714-278-1839",
"EnumerationDate": "03/12/2015",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumber1": "A69909",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumber2": "A69909",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "FQ161B",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(N)",
"OtherIdentifier3": "1114205432",
"OtherIdentifierType3": "MEDICAID",
"OtherIdentifierState3": "CA",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1457744625",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "5565 GROSSMONT CENTER DR # 2-3",
"PracticeLocationAddressCityName": "LA MESA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91942-3020",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-697-4600",
"PracticeLocationAddressFaxNumber": "619-464-5526",
"EnumerationDate": "03/12/2015",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumber1": "A69909",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumber2": "A69909",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1801267513",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8868",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "3816 WOODRUFF AVE STE 100",
"PracticeLocationAddressCityName": "LONG BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90808-2145",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-424-0931",
"PracticeLocationAddressFaxNumber": "562-492-9400",
"EnumerationDate": "10/08/2015",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "NULL",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "NULL",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1598110470",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "6945 EL CAJON BLVD",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92115-1754",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-697-4600",
"PracticeLocationAddressFaxNumber": "619-464-5526",
"EnumerationDate": "04/28/2016",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR (S)",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR (N)",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1134574015",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "4344 CONVOY ST STE C2",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92111-3737",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-565-8822",
"PracticeLocationAddressFaxNumber": "858-565-2449",
"EnumerationDate": "04/28/2016",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR (S)",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR (N)",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1043665920",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "14501 MAGNOLIA ST",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "WESTMINSTER",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92683-1306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-594-7575",
"PracticeLocationAddressFaxNumber": "714-594-7576",
"EnumerationDate": "04/28/2016",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1043665615",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "1640 NEWPORT BLVD",
"SecondLinePracticeLocationAddress": "220",
"PracticeLocationAddressCityName": "COSTA MESA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92627-3786",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-873-5046",
"PracticeLocationAddressFaxNumber": "949-873-5394",
"EnumerationDate": "05/02/2016",
"LastUpdateDate": "07/16/2016",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "NULL",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "NULL",
"PrimaryTaxonomySwitch2": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1881149060",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "47474 WASHINGTON ST",
"PracticeLocationAddressCityName": "LA QUINTA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92253-8846",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-564-2500",
"PracticeLocationAddressFaxNumber": "760-564-2577",
"EnumerationDate": "08/17/2016",
"LastUpdateDate": "04/01/2019",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1376098525",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "500 S ANAHEIM HILLS RD",
"SecondLinePracticeLocationAddress": "SUITE 240",
"PracticeLocationAddressCityName": "ANAHEIM",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92807-4780",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-921-0232",
"PracticeLocationAddressFaxNumber": "714-921-0535",
"EnumerationDate": "08/17/2016",
"LastUpdateDate": "08/17/2016",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1164977336",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "1801 E TAHQUITZ CANYON WAY STE 200",
"PracticeLocationAddressCityName": "PALM SPRINGS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92262-7123",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-327-2700",
"PracticeLocationAddressFaxNumber": "760-327-2799",
"EnumerationDate": "08/17/2016",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"OtherIdentifier2": "FQ161A",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(S)",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1811442056",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "301 W HUNTINGTON DR",
"SecondLinePracticeLocationAddress": "SUITE 107",
"PracticeLocationAddressCityName": "ARCADIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91007-3462",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-574-0188",
"PracticeLocationAddressFaxNumber": "626-574-0488",
"EnumerationDate": "08/17/2016",
"LastUpdateDate": "08/17/2016",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1326593583",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "44139 MONTEREY AVE",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "PALM DESERT",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92260-8700",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-779-0800",
"PracticeLocationAddressFaxNumber": "760-779-0801",
"EnumerationDate": "08/17/2016",
"LastUpdateDate": "08/17/2016",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1265989347",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-884-3805",
"MailingAddressFaxNumber": "626-796-7657",
"FirstLinePracticeLocationAddress": "18340 YORBA LINDA BLVD",
"SecondLinePracticeLocationAddress": "SUITE 108",
"PracticeLocationAddressCityName": "YORBA LINDA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92886-4058",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-577-6031",
"PracticeLocationAddressFaxNumber": "626-796-7657",
"EnumerationDate": "09/06/2016",
"LastUpdateDate": "09/06/2016",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "Y",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "152W00000X",
"PrimaryTaxonomy": "Optometrist"
},
{
"NPI": "1316482862",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "58471 29 PALMS HWY",
"SecondLinePracticeLocationAddress": "# 203",
"PracticeLocationAddressCityName": "YUCCA VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92284-5818",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-853-3005",
"PracticeLocationAddressFaxNumber": "760-853-3012",
"EnumerationDate": "12/19/2016",
"LastUpdateDate": "07/21/2022",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "NULL",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "FQ161B",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR(N)",
"OtherIdentifier3": "1114205432",
"OtherIdentifierType3": "MEDICAID",
"OtherIdentifierState3": "CA",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1831634815",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-568-8838",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "8616 LA TIJERA BLVD",
"SecondLinePracticeLocationAddress": "STE 102",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90045-3944",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-673-2020",
"PracticeLocationAddressFaxNumber": "310-649-5290",
"EnumerationDate": "12/29/2016",
"LastUpdateDate": "12/29/2016",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "174400000X",
"PrimaryTaxonomy": "Specialist"
},
{
"NPI": "1154862647",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"FirstLinePracticeLocationAddress": "47474 WASHINGTON ST",
"PracticeLocationAddressCityName": "LA QUINTA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92253-8846",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-564-2500",
"PracticeLocationAddressFaxNumber": "760-564-2577",
"EnumerationDate": "03/16/2017",
"LastUpdateDate": "04/01/2019",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "NULL",
"PrimaryTaxonomySwitch1": "Y",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "N",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR(S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR(N)",
"PrimaryTaxonomyCode": "152W00000X",
"PrimaryTaxonomy": "Optometrist"
},
{
"NPI": "1225560725",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-269-5357",
"MailingAddressFaxNumber": "626-574-7188",
"FirstLinePracticeLocationAddress": "435 ARDEN AVE",
"SecondLinePracticeLocationAddress": "430",
"PracticeLocationAddressCityName": "GLENDALE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91203-1130",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-539-8016",
"PracticeLocationAddressFaxNumber": "818-351-3657",
"EnumerationDate": "04/03/2017",
"LastUpdateDate": "04/03/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "Y",
"TaxonomyCode2": "207W00000X",
"Taxonomy2": "Ophthalmology Physician",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "GROUP NPI",
"PrimaryTaxonomyCode": "152W00000X",
"PrimaryTaxonomy": "Optometrist"
},
{
"NPI": "1568971174",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-269-5371",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "830 W VALLEY PKWY",
"PracticeLocationAddressCityName": "ESCONDIDO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92025-2529",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-743-5872",
"PracticeLocationAddressFaxNumber": "760-743-5879",
"EnumerationDate": "09/26/2017",
"LastUpdateDate": "09/26/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "FOUNDER/ OWNER",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "1114205432",
"OtherIdentifierType1": "MEDICAID",
"OtherIdentifierState1": "CA",
"OtherIdentifier2": "FQ161B",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR (N)",
"OtherIdentifier3": "FQ161A",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR (S)",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1578072187",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-269-5371",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "2240 E PLAZA BLVD STE F&G",
"PracticeLocationAddressCityName": "NATIONAL CITY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91950-5164",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-470-2700",
"PracticeLocationAddressFaxNumber": "619-236-7822",
"EnumerationDate": "09/26/2017",
"LastUpdateDate": "09/26/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER/ OWNER",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR (S)",
"OtherIdentifier2": "1114205432",
"OtherIdentifierType2": "MEDICAID",
"OtherIdentifierState2": "CA",
"OtherIdentifier3": "FQ161B",
"OtherIdentifierType3": "OTHER",
"OtherIdentifierState3": "CA",
"OtherIdentifierIssuer3": "MCR (N)",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
},
{
"NPI": "1821507435",
"EntityType": "Organization",
"IsOrgSubpart": "N",
"OrgName": "TRILOGY EYE MEDICAL GROUP, INC.",
"OtherOrgNameTypeCode": "6",
"FirstLineMailingAddress": "100 E CALIFORNIA BLVD",
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91105-3205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-269-5371",
"MailingAddressFaxNumber": "626-577-2100",
"FirstLinePracticeLocationAddress": "1620 ALPINE BLVD STE 117",
"PracticeLocationAddressCityName": "ALPINE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91901-1103",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-445-2687",
"PracticeLocationAddressFaxNumber": "619-445-0801",
"EnumerationDate": "09/26/2017",
"LastUpdateDate": "09/26/2017",
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "FOUNDER/ OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "626-568-8838",
"TaxonomyCode1": "152W00000X",
"Taxonomy1": "Optometrist",
"LicenseNumberStateCode1": "CA",
"PrimaryTaxonomySwitch1": "N",
"TaxonomyCode2": "174400000X",
"Taxonomy2": "Specialist",
"LicenseNumberStateCode2": "CA",
"PrimaryTaxonomySwitch2": "N",
"TaxonomyCode3": "207W00000X",
"Taxonomy3": "Ophthalmology Physician",
"LicenseNumberStateCode3": "CA",
"PrimaryTaxonomySwitch3": "Y",
"OtherIdentifier1": "FQ161A",
"OtherIdentifierType1": "OTHER",
"OtherIdentifierState1": "CA",
"OtherIdentifierIssuer1": "MCR (S)",
"OtherIdentifier2": "FQ161B",
"OtherIdentifierType2": "OTHER",
"OtherIdentifierState2": "CA",
"OtherIdentifierIssuer2": "MCR (N)",
"OtherIdentifier3": "1114205432",
"OtherIdentifierType3": "MEDICAID",
"OtherIdentifierState3": "CA",
"PrimaryTaxonomyCode": "207W00000X",
"PrimaryTaxonomy": "Ophthalmology Physician"
}
]
}
{"NPI":[{"NPI":"1053584474","OrgName":"TRILOGY EYE MEDICAL GROUP, INC","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"5565 GROSSMONT CENTER DR STE 551","PracticeLocationAddressCityName":"LA MESA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91942-3078","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"619-465-2020","PracticeLocationAddressFaxNumber":"619-698-1189"},{"NPI":"1114205432","OrgName":"TRILOGY EYE MEDICAL GROUP INC","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"100 E CALIFORNIA BLVD","PracticeLocationAddressCityName":"PASADENA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91105-3205","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"626-568-8838","PracticeLocationAddressFaxNumber":"626-796-7657"},{"NPI":"1235570607","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"207 S SANTA ANITA AVE","SecondLinePracticeLocationAddress":"SUITE P-25","PracticeLocationAddressCityName":"SAN GABRIEL","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91776-1146","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"626-269-5355","PracticeLocationAddressFaxNumber":"626-284-8448"},{"NPI":"1982045449","OrgName":"TRILOGY EYE MEDICAL GROUP, INC","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"17833 COLIMA RD","PracticeLocationAddressCityName":"CITY OF INDUSTRY","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91748-1729","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"626-965-8895","PracticeLocationAddressFaxNumber":"626-965-8876"},{"NPI":"1588099097","OrgName":"TRILOGY EYE MEDICAL GROUP, INC","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"2400 N BROADWAY","PracticeLocationAddressCityName":"LOS ANGELES","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"90031-2219","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"323-221-8000","PracticeLocationAddressFaxNumber":"323-221-0738"},{"NPI":"1366850471","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"4413 LA JOLLA VILLAGE DR STE P-1","PracticeLocationAddressCityName":"SAN DIEGO","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92122-1264","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"858-320-0075","PracticeLocationAddressFaxNumber":"858-320-0053"},{"NPI":"1558754762","OrgName":"TRIOLOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"116 N PLAZA ST","PracticeLocationAddressCityName":"BRAWLEY","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92227-2426","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-344-4330","PracticeLocationAddressFaxNumber":"760-344-6956"},{"NPI":"1184017261","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"1420 OCOTILLO DR","SecondLinePracticeLocationAddress":"SUITE D","PracticeLocationAddressCityName":"EL CENTRO","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92243-4254","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-353-1140","PracticeLocationAddressFaxNumber":"760-353-1153"},{"NPI":"1851784011","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"44815 FIG AVE","PracticeLocationAddressCityName":"LANCASTER","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"93534-3144","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"661-206-9753","PracticeLocationAddressFaxNumber":"661-941-4302"},{"NPI":"1205229382","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"14642 NEWPORT AVE","SecondLinePracticeLocationAddress":"SUITE 210","PracticeLocationAddressCityName":"TUSTIN","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92780-6057","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"714-884-3957","PracticeLocationAddressFaxNumber":"714-884-3458"},{"NPI":"1033502273","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"2240 N HARBOR BLVD","SecondLinePracticeLocationAddress":"210","PracticeLocationAddressCityName":"FULLERTON","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92835-2631","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"714-278-1834","PracticeLocationAddressFaxNumber":"714-278-1839"},{"NPI":"1457744625","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"5565 GROSSMONT CENTER DR # 2-3","PracticeLocationAddressCityName":"LA MESA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91942-3020","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"619-697-4600","PracticeLocationAddressFaxNumber":"619-464-5526"},{"NPI":"1801267513","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"3816 WOODRUFF AVE STE 100","PracticeLocationAddressCityName":"LONG BEACH","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"90808-2145","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"562-424-0931","PracticeLocationAddressFaxNumber":"562-492-9400"},{"NPI":"1598110470","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"6945 EL CAJON BLVD","PracticeLocationAddressCityName":"SAN DIEGO","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92115-1754","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"619-697-4600","PracticeLocationAddressFaxNumber":"619-464-5526"},{"NPI":"1134574015","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"4344 CONVOY ST STE C2","PracticeLocationAddressCityName":"SAN DIEGO","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92111-3737","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"858-565-8822","PracticeLocationAddressFaxNumber":"858-565-2449"},{"NPI":"1043665920","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"14501 MAGNOLIA ST","SecondLinePracticeLocationAddress":"SUITE 103","PracticeLocationAddressCityName":"WESTMINSTER","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92683-1306","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"714-594-7575","PracticeLocationAddressFaxNumber":"714-594-7576"},{"NPI":"1043665615","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"1640 NEWPORT BLVD","SecondLinePracticeLocationAddress":"220","PracticeLocationAddressCityName":"COSTA MESA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92627-3786","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"949-873-5046","PracticeLocationAddressFaxNumber":"949-873-5394"},{"NPI":"1881149060","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"47474 WASHINGTON ST","PracticeLocationAddressCityName":"LA QUINTA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92253-8846","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-564-2500","PracticeLocationAddressFaxNumber":"760-564-2577"},{"NPI":"1376098525","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"500 S ANAHEIM HILLS RD","SecondLinePracticeLocationAddress":"SUITE 240","PracticeLocationAddressCityName":"ANAHEIM","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92807-4780","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"714-921-0232","PracticeLocationAddressFaxNumber":"714-921-0535"},{"NPI":"1164977336","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"1801 E TAHQUITZ CANYON WAY STE 200","PracticeLocationAddressCityName":"PALM SPRINGS","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92262-7123","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-327-2700","PracticeLocationAddressFaxNumber":"760-327-2799"},{"NPI":"1811442056","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"301 W HUNTINGTON DR","SecondLinePracticeLocationAddress":"SUITE 107","PracticeLocationAddressCityName":"ARCADIA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91007-3462","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"626-574-0188","PracticeLocationAddressFaxNumber":"626-574-0488"},{"NPI":"1326593583","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"44139 MONTEREY AVE","SecondLinePracticeLocationAddress":"SUITE A","PracticeLocationAddressCityName":"PALM DESERT","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92260-8700","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-779-0800","PracticeLocationAddressFaxNumber":"760-779-0801"},{"NPI":"1265989347","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"18340 YORBA LINDA BLVD","SecondLinePracticeLocationAddress":"SUITE 108","PracticeLocationAddressCityName":"YORBA LINDA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92886-4058","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"714-577-6031","PracticeLocationAddressFaxNumber":"626-796-7657"},{"NPI":"1316482862","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"58471 29 PALMS HWY","SecondLinePracticeLocationAddress":"# 203","PracticeLocationAddressCityName":"YUCCA VALLEY","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92284-5818","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-853-3005","PracticeLocationAddressFaxNumber":"760-853-3012"},{"NPI":"1831634815","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"8616 LA TIJERA BLVD","SecondLinePracticeLocationAddress":"STE 102","PracticeLocationAddressCityName":"LOS ANGELES","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"90045-3944","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"310-673-2020","PracticeLocationAddressFaxNumber":"310-649-5290"},{"NPI":"1154862647","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"47474 WASHINGTON ST","PracticeLocationAddressCityName":"LA QUINTA","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92253-8846","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-564-2500","PracticeLocationAddressFaxNumber":"760-564-2577"},{"NPI":"1225560725","OrgName":"TRILOGY EYE MEDICAL GROUP, INC","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"435 ARDEN AVE","SecondLinePracticeLocationAddress":"430","PracticeLocationAddressCityName":"GLENDALE","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91203-1130","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"818-539-8016","PracticeLocationAddressFaxNumber":"818-351-3657"},{"NPI":"1568971174","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"830 W VALLEY PKWY","PracticeLocationAddressCityName":"ESCONDIDO","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"92025-2529","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"760-743-5872","PracticeLocationAddressFaxNumber":"760-743-5879"},{"NPI":"1578072187","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"2240 E PLAZA BLVD STE F&G","PracticeLocationAddressCityName":"NATIONAL CITY","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91950-5164","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"619-470-2700","PracticeLocationAddressFaxNumber":"619-236-7822"},{"NPI":"1821507435","OrgName":"TRILOGY EYE MEDICAL GROUP, INC.","OtherOrgNameTypeCode":"6","FirstLinePracticeLocationAddress":"1620 ALPINE BLVD STE 117","PracticeLocationAddressCityName":"ALPINE","PracticeLocationAddressStateName":"CA","PracticeLocationAddressPostalCode":"91901-1103","PracticeLocationAddressCountryCode":"US","PracticeLocationAddressTelephoneNumber":"619-445-2687","PracticeLocationAddressFaxNumber":"619-445-0801"}]}