Provider Demographics
NPI:1861048506
Name:KUEI-YU CHANG O.D. INC., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KUEI-YU CHANG O.D. INC., A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN-TRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-793-9666
Mailing Address - Street 1:8519 IRVINE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4298
Mailing Address - Country:US
Mailing Address - Phone:657-229-0977
Mailing Address - Fax:949-585-9162
Practice Address - Street 1:8519 IRVINE CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4298
Practice Address - Country:US
Practice Address - Phone:949-585-9403
Practice Address - Fax:949-585-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15157TLGOtherOPTOMETRY LICENSE