Provider Demographics
NPI:1497382212
Name:CHANG, NATASHA (OD)
Entity Type:Individual
Prefix:
First Name:NATASHA
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 1:570 GYPSY LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2144
Mailing Address - Country:US
Mailing Address - Phone:330-743-9816
Mailing Address - Fax:330-918-6066
Practice Address - Street 1:570 GYPSY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2144
Practice Address - Country:US
Practice Address - Phone:330-743-9816
Practice Address - Fax:330-918-6066
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006895152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist