Provider Demographics
NPI:1558536482
Name:CLIFFORD KARL CHANG OD INC.
Entity type:Organization
Organization Name:CLIFFORD KARL CHANG OD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-982-1700
Mailing Address - Street 1:929 CLAY ST
Mailing Address - Street 2:203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1556
Mailing Address - Country:US
Mailing Address - Phone:415-982-1700
Mailing Address - Fax:415-982-1750
Practice Address - Street 1:929 CLAY ST
Practice Address - Street 2:203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1556
Practice Address - Country:US
Practice Address - Phone:415-982-1700
Practice Address - Fax:415-982-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558536482OtherNPI NUMBER
CA0288920001Medicare NSC
CASD0040710Medicare PIN