Provider Demographics
NPI:1568687630
Name:CHANG, DENNIS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
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 1:401 E NEWPORT LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1144
Mailing Address - Country:US
Mailing Address - Phone:956-682-4747
Mailing Address - Fax:
Practice Address - Street 1:601 E EXPRESSWAY 83 STE 100B
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-4978
Practice Address - Country:US
Practice Address - Phone:956-969-2816
Practice Address - Fax:956-968-6956
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4067T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO-80289E4Medicaid
TXPO-80289E4Medicaid
TXPO-80289E4Medicaid