MEDICARE: JACQUELINE CHANG

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	152WC0802X	Corneal and Contact Management Optometrist	008357	NY

General Provider Information

NPI Number	:	1366858045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE CHANG

Provider Business Mailing Address
First Line	:	159 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4343
Country	:	US
Telephone Number	:	718-551-0591
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4343
Country	:	US
Telephone Number	:	718-551-0591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	10/11/2016

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Directions to “ JACQUELINE CHANG ” Practice Location

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