Provider Demographics
NPI:1932120540
Name:CHANG, LENA BRENDA (OD)
Entity Type:Individual
Prefix:MS
First Name:LENA
Middle Name:BRENDA
Last Name:CHANG
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 1:15333 CULVER DRIVE
Mailing Address - Street 2:SUITE 690
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-552-4271
Mailing Address - Fax:949-552-0321
Practice Address - Street 1:15333 CULVER DR
Practice Address - Street 2:SUITE 690
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3078
Practice Address - Country:US
Practice Address - Phone:949-552-4271
Practice Address - Fax:949-552-0321
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10106T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300273079Medicaid
CAWOP10106AMedicare PIN
CAU48826Medicare UPIN