Provider Demographics
NPI:1710502299
Name:YE, CHANG (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:
Last Name:YE
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SPRINGWOOD CONNECTOR UNIT 515
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5886
Mailing Address - Country:US
Mailing Address - Phone:617-470-8165
Mailing Address - Fax:
Practice Address - Street 1:800 MOUNT VERNON HWY NE STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4293
Practice Address - Country:US
Practice Address - Phone:770-255-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist