Provider Demographics
NPI:1558055657
Name:CHANG, SORAYA ELIZABETH (LDO)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:ELIZABETH
Last Name:CHANG
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-1215
Mailing Address - Country:US
Mailing Address - Phone:914-727-2378
Mailing Address - Fax:
Practice Address - Street 1:56 W MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2243
Practice Address - Country:US
Practice Address - Phone:845-896-8741
Practice Address - Fax:845-896-8783
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7779156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician