Provider Demographics
NPI:1790878114
Name:CHANG, AMOS (OD)
Entity Type:Individual
Prefix:DR
First Name:AMOS
Middle Name:
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 1:9015 QUEENS BLVD
Mailing Address - Street 2:SUITE # 2111
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4900
Mailing Address - Country:US
Mailing Address - Phone:718-699-2879
Mailing Address - Fax:718-699-2749
Practice Address - Street 1:9015 QUEENS BLVD
Practice Address - Street 2:SUITE # 2111
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4900
Practice Address - Country:US
Practice Address - Phone:718-699-2879
Practice Address - Fax:718-699-2749
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006298 VUT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCGWCD1Medicare ID - Type UnspecifiedGROUP PROVIDER #
NYU77096Medicare UPIN