Provider Demographics
NPI:1639242019
Name:CHANG SMITH, ANA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:
Last Name:CHANG SMITH
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 1:16835 ALGONQUIN ST
Mailing Address - Street 2:SUITE 383
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3810
Mailing Address - Country:US
Mailing Address - Phone:714-794-9871
Mailing Address - Fax:
Practice Address - Street 1:16845 ALGONQUIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3810
Practice Address - Country:US
Practice Address - Phone:714-841-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10300T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW0P10300AMedicare ID - Type Unspecified
CASD0103000Medicaid
U55767Medicare UPIN