Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 27OA00615000 | NJ |
Y | 152W00000X | Optometrist | TUV0072751 | NY |
NPI | 1003079393 |
---|---|
Provider Name | Dr. Ying Chieh Tina Chang |
First Address | Jersey City, NJ 07310-1603 |
Second Address | Jersey City, NJ 07310-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 28/08/2008 |