Provider Demographics
NPI:1285048629
Name:CHANG, MILLIE (OD)
Entity type:Individual
Prefix:
First Name:MILLIE
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 1:8160 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2615
Mailing Address - Country:US
Mailing Address - Phone:301-490-3036
Mailing Address - Fax:
Practice Address - Street 1:8160 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2615
Practice Address - Country:US
Practice Address - Phone:301-490-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2425152W00000X
VA0618002342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist