Individual provider Active NPI

Patricia Chang, O.D.

  • Optometrist
  • Millbrae, CA
National Provider Identifier
1386796480
Registry record updated Mar 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6412T Issued in CA
Practice address
305 Broadway
Millbrae, CA 94030-2509
Phone
(650) 697-2475
Fax
(650) 692-7154
NPI assigned
Jan 17, 2007
Last updated
Mar 18, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6412T CA Primary

Addresses

Primary practice location

305 Broadway
Millbrae, CA 94030-2509

Mailing address

305 Broadway
Millbrae, CA 94030-2509
Phone (650) 697-2475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6412TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Elena Wong O.D., Inc. Optometrist CurrentSince Jan 5, 2020 Accepting new patients
Palo Alto Medical Foundation PastSince Mar 1, 2012 Accepting new patients

Locations

1019 Alameda de las Pulgas
Belmont, CA 94002
Phone (650) 594-1019

Organizations & group practices 3

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": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300406400000",
    "number": "1386796480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 BROADWAY",
            "city": "MILLBRAE",
            "state": "CA",
            "postal_code": "940302509",
            "telephone_number": "650-697-2475",
            "fax_number": "650-692-7154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 BROADWAY",
            "city": "MILLBRAE",
            "state": "CA",
            "postal_code": "940302509",
            "telephone_number": "650-697-2475",
            "fax_number": "650-692-7154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "PATRICIA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2011-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6412T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.