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NPI Code Detail

MEDICARE: CINDY CHANG OD INC

MEDICARE: CINDY 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
1152W00000XOptometrist12307CA

General Provider Information

NPI Number : 1417336082
Entity Type Code : Organization
Provider Name (Legal Business Name) : CINDY CHANG OD INC
Provider Business Mailing Address
First Line : 3305 SAGE ST
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1935
Country : US
Telephone Number : 425-256-1563
Fax Number :
Provider Business Practice Location Address
First Line : 4200 E 4TH ST
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5250
Country : US
Telephone Number : 909-579-3040
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CINDY CHANG
Credential :
Telephone Number : 425-256-1563
Provider Enumeration Date : 05/28/2015
Last Update Date : 05/28/2015

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