Organization
RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM CHANG MD (MANAGING PARTNER)
(800) 898-2020
Entity
Organization
Contact information
Practice address
320 SANTA FE DR STE 104, ENCINITAS, CA 92024-5139
(760) 943-7141
(760) 943-0371
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(951) 249-9225
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760541569
—
CA
Enumeration date
02/04/2019
Last updated
03/30/2021
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