Provider Demographics
NPI:1982045449
Name:TRILOGY EYE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:TRILOGY EYE MEDICAL GROUP, INC
Other - Org Name:CALIFORNIA EYE AND EAR SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-289-2223
Mailing Address - Street 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:626-574-0020
Mailing Address - Fax:626-574-7188
Practice Address - Street 1:17833 COLIMA RD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1729
Practice Address - Country:US
Practice Address - Phone:626-965-8895
Practice Address - Fax:626-965-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
CA174400000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFQ161BOtherMCR(N)
CA1114205432Medicaid
CAFQ161AOtherMCR(S)
CAFQ161AOtherMCR(S)
CAFQ161BOtherMCR(N)