Organization
TRILOGY EYE MEDICAL GROUP, INC.
Active
Other names
ACUITY EYE SPECIALISTS
Organization subpart
No
Provider details
NPI number
Authorized official
TOM S CHANG M.D. (PRESIDENT)
(626) 568-8838
Entity
Organization
Contact information
Practice address
4413 LA JOLLA VILLAGE DR STE P-1, SAN DIEGO, CA 92122-1264
(858) 320-0075
(858) 320-0053
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(888) 884-3805
(626) 574-7188
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
CA
174400000X
Specialist
—
CA
207W00000X
Ophthalmology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114205432
—
CA
01
—
FQ161A
MCR (S)
CA
01
—
FQ161B
MCR (N)
CA
Enumeration date
08/01/2014
Last updated
07/21/2022
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