MEDICARE: DR. AMOS CHANG O.D.

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	006298 VUT	NY

General Provider Information

NPI Number	:	1790878114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMOS CHANG O.D.

Provider Business Mailing Address
First Line	:	9015 QUEENS BLVD
Second Line	:	SUITE # 2111
City	:	ELMHURST
State	:	NY
Zip	:	11373-4900
Country	:	US
Telephone Number	:	718-699-2879
Fax Number	:	718-699-2749

Provider Business Practice Location Address
First Line	:	9015 QUEENS BLVD
Second Line	:	SUITE # 2111
City	:	ELMHURST
State	:	NY
Zip	:	11373-4900
Country	:	US
Telephone Number	:	718-699-2879
Fax Number	:	718-699-2749

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/08/2007

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