MEDICARE: KUEI-YU CHANG O.D. INC., A PROFESSIONAL CORPORATION

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
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15157TLG	OTHER	CA	OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1861048506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUEI-YU CHANG O.D. INC., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	8519 IRVINE CENTER DR
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-4298
Country	:	US
Telephone Number	:	657-229-0977
Fax Number	:	949-585-9162

Provider Business Practice Location Address
First Line	:	8519 IRVINE CENTER DR
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-4298
Country	:	US
Telephone Number	:	949-585-9403
Fax Number	:	949-585-9162

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MR. KHIEM NGUYEN-TRONG
Credential	:
Telephone Number	:	818-793-9666

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	10/05/2024

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