Organization
RETINA INSTITUTE OF CA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM S CHANG MD (OWNER)
(626) 568-8838
Entity
Organization
Contact information
Practice address
14501 MAGNOLIA ST STE 103, WESTMINSTER, CA 92683-1307
(714) 594-7575
(714) 594-7567
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(626) 269-5357
(626) 574-7188
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
A69909
CA
207W00000X
Ophthalmology Physician
Primary
A69909
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760541569
—
CA
Enumeration date
06/09/2016
Last updated
06/09/2016
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