Provider Demographics
NPI:1326412529
Name:CHANG, CHRISTINA AIMEE (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:AIMEE
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 1:1551 SLOAT BLVD
Mailing Address - Street 2:C/O VISIONARIUM OPTOMETRY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1222
Mailing Address - Country:US
Mailing Address - Phone:415-753-5338
Mailing Address - Fax:415-753-0978
Practice Address - Street 1:1551 SLOAT BLVD
Practice Address - Street 2:C/O VISIONARIUM OPTOMETRY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1222
Practice Address - Country:US
Practice Address - Phone:415-753-5338
Practice Address - Fax:415-753-0978
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11558T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist