MEDICARE: RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	A69909	CA
2	174400000X	Specialist	A69909	CA
3	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1760541569	OTHER	CA	GROUP NPI

General Provider Information

NPI Number	:	1215320429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR

Provider Business Mailing Address
First Line	:	100 E CALIFORNIA BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3205
Country	:	US
Telephone Number	:	626-568-8868
Fax Number	:	626-574-7188

Provider Business Practice Location Address
First Line	:	1801 E TAHQUITZ CANYON WAY STE 200&201
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7120
Country	:	US
Telephone Number	:	760-327-2700
Fax Number	:	760-327-2799

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. TOM S CHANG
Credential	:	MD
Telephone Number	:	626-568-8838

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/28/2022

Similar Medicare Providers

1972573103 — DR. SANJEEV GREWAL M.D.
Practice Location Address:

1801 E TAHQUITZ CANYON WAY , SUITE 200
PALM SPRINGS, CA
92262-7120

Practice Phone: 800-898-2020
Practice Fax:

1639500929 — ALEXANDER A VILLARASA MD
Practice Location Address:

1801 E TAHQUITZ CANYON WAY , STE 102
PALM SPRINGS, CA
92262-7120

Practice Phone: 760-327-5900
Practice Fax: 760-327-5905

1821968876 — ISMARI RIVERO ESTEVEZ
Practice Location Address:

2373 RUE RD
WEST PALM BEACH, FL
33415-7120

Practice Phone: 561-400-9153
Practice Fax:

1043362783 — MRS. MELISSA D CAVENDER M.ED. CCC-SLP
Practice Location Address:

2015 N FRANKLIN ST
COLORADO SPRINGS, CO
80907-7120

Practice Phone: 719-641-5325
Practice Fax:

1265799787 — TARA LESLIE STEPHEN CPM
Practice Location Address:

7120 SILVER PONDS HTS
COLORADO SPRINGS, CO
80908-4765

Practice Phone: 719-330-1851
Practice Fax: 719-494-2238

1255882619 — EDGE MEDICAL SERVICES
Practice Location Address:

7120 SILVER PONDS HTS
COLORADO SPRINGS, CO
80908-4765

Practice Phone: 800-348-4623
Practice Fax:

Directions to “RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.