Provider Demographics
NPI:1447214390
Name:TRILOGY EYE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:TRILOGY EYE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:626-568-8838
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:626-574-7188
Practice Address - Street 1:44241 15TH ST W
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5501
Practice Address - Country:US
Practice Address - Phone:661-949-5955
Practice Address - Fax:661-949-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-15
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFQ161AMedicare UPIN
CAW11091Medicare ID - Type Unspecified
CAGR0045930Medicaid