Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 13962 | CA |
NPI | 1013229228 |
---|---|
Provider Name | Annie Chang |
First Address | Berkeley, CA 94704-1973 |
Second Address | Berkeley, CA 94704-1973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 06/07/2010 |