Provider Demographics
NPI:1093005050
Name:TIFFANY W. CHANG, OD, INC.
Entity Type:Organization
Organization Name:TIFFANY W. CHANG, OD, INC.
Other - Org Name:CUPERTINO OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:WEI
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-354-8937
Mailing Address - Street 1:10430 S DE ANZA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3098
Mailing Address - Country:US
Mailing Address - Phone:408-865-0440
Mailing Address - Fax:408-865-0411
Practice Address - Street 1:10430 S DE ANZA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3098
Practice Address - Country:US
Practice Address - Phone:408-865-0440
Practice Address - Fax:408-865-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATPL 13471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17623Medicare UPIN
CACK662ZMedicare PIN