Provider Demographics
NPI:1558539007
Name:CHANG, CLIFFORD KARL (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:KARL
Last Name:CHANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CLAY ST
Mailing Address - Street 2:203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1556
Mailing Address - Country:US
Mailing Address - Phone:415-982-1700
Mailing Address - Fax:415-982-1750
Practice Address - Street 1:929 CLAY ST
Practice Address - Street 2:203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1556
Practice Address - Country:US
Practice Address - Phone:415-982-1700
Practice Address - Fax:415-982-1750
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0288920001OtherSUPPLIER NUMBER
CA0288920001OtherSUPPLIER NUMBER