Provider Demographics
NPI:1821110883
Name:CHI CHANG OD, INC.
Entity Type:Organization
Organization Name:CHI CHANG OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-769-1918
Mailing Address - Street 1:3507 149TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6984
Mailing Address - Country:US
Mailing Address - Phone:206-769-1918
Mailing Address - Fax:360-805-0467
Practice Address - Street 1:18805 STATE ROUTE 2 STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1438
Practice Address - Country:US
Practice Address - Phone:360-805-9323
Practice Address - Fax:360-805-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3812TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty