Provider Demographics
NPI:1891871927
Name:CHANG, TROY HAJIN (OD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:HAJIN
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 1:2595 S MARYLAND PKWY
Mailing Address - Street 2:STE 106
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-8305
Mailing Address - Country:US
Mailing Address - Phone:702-220-9767
Mailing Address - Fax:702-796-6636
Practice Address - Street 1:2595 S MARYLAND PKWY
Practice Address - Street 2:STE 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-8305
Practice Address - Country:US
Practice Address - Phone:702-220-9767
Practice Address - Fax:702-796-6636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1891871927Medicaid
NVCL992ZMedicare PIN