Provider Demographics
NPI:1811617574
Name:CHANG, WISELIE (OD)
Entity type:Individual
Prefix:
First Name:WISELIE
Middle Name:
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 1:18391 CARNABY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1407
Mailing Address - Country:US
Mailing Address - Phone:714-333-7432
Mailing Address - Fax:
Practice Address - Street 1:857 SPECTRUM CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4959
Practice Address - Country:US
Practice Address - Phone:855-550-0743
Practice Address - Fax:877-277-6340
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist