MEDICARE: CHRISTINE M CHANG OD INC

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	11110T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356430490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE M CHANG OD INC

Provider Business Mailing Address
First Line	:	2359 S AZUSA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792
Country	:	US
Telephone Number	:	626-913-2244
Fax Number	:	626-913-6204

Provider Business Practice Location Address
First Line	:	2359 S AZUSA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792
Country	:	US
Telephone Number	:	626-913-2244
Fax Number	:	626-913-6204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTINE M CHANG
Credential	:	OD
Telephone Number	:	626-913-2244

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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