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NPI Code Detail

MEDICARE: JEWELL R. CHANG OD PA

MEDICARE: JEWELL R. CHANG OD PA
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
1152W00000XOptometristOPC2950FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120621OTHERBLUE CROSS BLUE SHIELD
25624127OTHERAETNA

General Provider Information

NPI Number : 1841314945
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEWELL R. CHANG OD PA
Provider Business Mailing Address
First Line : 3201 NE SKYLINE DR
Second Line : SUITE 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
Second Line : SUITE D
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 : PRESIDENT
Name : DR. JEWELL RENEE CHANG
Credential : OD
Telephone Number : 772-334-4264
Provider Enumeration Date : 03/16/2007
Last Update Date : 12/04/2008

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Directions to “JEWELL R. CHANG OD PA ” Practice Location

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