MEDICARE: DR. JEWELL RENEE CHANG OD

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	OPC2950	FL

General Provider Information

NPI Number	:	1407830730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEWELL RENEE CHANG OD

Provider Business Mailing Address
First Line	:	3201 NE SKYLINE DR
Second Line	:	STE D
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3912
Country	:	US
Telephone Number	:	772-334-4264
Fax Number	:	772-334-4265

Provider Business Practice Location Address
First Line	:	3201 NE SKYLINE DR STE D
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3912
Country	:	US
Telephone Number	:	772-334-4264
Fax Number	:	772-334-4265

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/11/2018

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