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Organization
RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR
Active
Organization
RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOM S. CHANG M.D. (FOUNDER)
(626) 568-8838
Entity
Organization
Contact information
Practice address
47474 WASHINGTON ST, LA QUINTA, CA 92253-8846
(760) 564-2500
(760) 564-2577
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(626) 568-8838
(626) 574-7188
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
A69909
CA
174400000X
Specialist
Primary
A69909
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760541569
GROUP NPI
CA
Enumeration date
03/12/2015
Last updated
03/30/2021
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