MEDICARE: TRILOGY EYE MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	152W00000X	Optometrist
2	174400000X	Specialist	CA
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	CA
4	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FQ161B	OTHER	CA	MCR(N)
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	FQ161A	OTHER	CA	MCR(S)

General Provider Information

NPI Number	:	1982045449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRILOGY EYE MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	100 E CALIFORNIA BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3205
Country	:	US
Telephone Number	:	626-574-0020
Fax Number	:	626-574-7188

Provider Business Practice Location Address
First Line	:	17833 COLIMA RD
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1729
Country	:	US
Telephone Number	:	626-965-8895
Fax Number	:	626-965-8876

Authorized Official
Title or Position	:	FOUNDER/OWNER
Name	:	DR. TOM S CHANG
Credential	:	MD
Telephone Number	:	626-289-2223

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/21/2022

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