Provider Demographics
NPI:1396896833
Name:CHANG, ELIZABETH Y (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:Y
Other - Last Name:CHEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 34581
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1581
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:10202 NE 185TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3456
Practice Address - Country:US
Practice Address - Phone:425-486-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003803152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029981Medicaid
WAP00734180OtherRAILROAD
WA248524OtherL&I
WAG8850939Medicare PIN
WAU99252Medicare UPIN
WA2029981Medicaid
WAG8850942Medicare PIN
WAP00734180OtherRAILROAD
WAG8850943Medicare PIN
WAG8850940Medicare PIN