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Organization
OPTOMETRIC EYE INSTITUTE PC
Active
Organization
OPTOMETRIC EYE INSTITUTE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA CHANG O.D. (OWNER)
(213) 627-9771
Entity
Organization
Contact information
Practice address
842 S BROADWAY, LOS ANGELES, CA 90014
(213) 627-9771
(213) 627-3146
Mailing address
842 S BROADWAY, LOS ANGELES, CA 90014
(213) 627-9771
(213) 627-3146
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12236T
CA
152W00000X
Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W18409
MEDICARE GROUP ID
CA
Enumeration date
10/26/2007
Last updated
03/19/2009
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