Provider Demographics
NPI:1407882327
Name:CHANG, EUNICE (OD)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
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 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 EARLE BROWN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2506
Practice Address - Country:US
Practice Address - Phone:952-993-4900
Practice Address - Fax:952-993-4827
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-03203OtherMEDICA
MNHP59874OtherHEALTHPARTNERS
MN1032781OtherPREFERRED ONE
MN2422247OtherARAZ
WI38628700Medicaid
MN410002619Medicare ID - Type UnspecifiedMN MEDICARE
MN1032781OtherPREFERRED ONE