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 (FOUNDER)
(626) 568-8838
Entity
Organization
Contact information
Practice address
6906 BROCKTON AVE, STE. 6, RIVERSIDE, CA 92506-4090
(951) 784-8373
(951) 784-8377
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
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
10/08/2021
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