Provider Demographics
NPI:1114205432
Name:TRILOGY EYE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TRILOGY EYE MEDICAL GROUP INC
Other - Org Name:CALIFORNIA EYE AND EAR SPECIALISTS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-269-5311
Mailing Address - Street 1:100 E. CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:888-884-3805
Mailing Address - Fax:626-796-7657
Practice Address - Street 1:100 E CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3205
Practice Address - Country:US
Practice Address - Phone:626-568-8838
Practice Address - Fax:626-796-7657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY EYE MEDICAL GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-03
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114205432Medicaid
CA1114205432Medicaid
CAFQ161AMedicare UPIN