Provider Demographics
NPI:1073976635
Name:CHANG, NICOLE NOELANI (OD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NOELANI
Last Name:CHANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-050 FARRINGTON HWY STE B1-1
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1800
Mailing Address - Country:US
Mailing Address - Phone:808-677-1544
Mailing Address - Fax:808-671-3538
Practice Address - Street 1:94-050 FARRINGTON HWY STE B1-1
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-677-1544
Practice Address - Fax:808-671-3538
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI876152W00000X
CA33681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist