Individual provider Active NPI

Jessica Chang, OD

  • Optometrist
  • Pasadena, CA
National Provider Identifier
1063524304
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10578T Issued in CA
Practice address
477 E Colorado Blvd
Pasadena, CA 91101-2024
Phone
(626) 796-1191
Fax
(626) 796-0189
NPI assigned
Aug 31, 2006
Last updated
Jul 30, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10578T CA Primary

Addresses

Primary practice location

477 E Colorado Blvd
Pasadena, CA 91101-2024

Mailing address

477 E Colorado Blvd
Pasadena, CA 91101-2024
Phone (626) 796-1191

Other identifiers 1

IdentifierTypeStateIssuer
SD0105780MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101101000257 CA Practitioner - Optometry 7113111402 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10578TCAMDOptometrist
10578CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Linden Optometry a Professional Corporation Optometrist CurrentSince Sep 12, 2010 Accepting new patients

Locations

477 E Colorado Blvd
Pasadena, CA 91101
Phone (626) 796-1191

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1063524304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012024",
            "telephone_number": "626-796-1191",
            "fax_number": "626-796-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012024",
            "telephone_number": "626-796-1191",
            "fax_number": "626-796-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JESSICA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10578T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0105780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.