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 MD (CHIEF OPERATING OFFICER)
(626) 568-8838
Entity
Organization
Contact information
Practice address
1801 E TAHQUITZ CANYON WAY STE 200&201, PALM SPRINGS, CA 92262-7120
(760) 327-2700
(760) 327-2799
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(626) 568-8868
(626) 574-7188
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
A69909
CA
174400000X
Specialist
A69909
CA
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760541569
GROUP NPI
CA
Enumeration date
03/12/2015
Last updated
03/28/2022
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