Provider Demographics
NPI:1396923975
Name:CHANG & ENGLE MDS, PC
Entity type:Organization
Organization Name:CHANG & ENGLE MDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-329-2300
Mailing Address - Street 1:5420 KIETZKE LN
Mailing Address - Street 2:STE 103
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2063
Mailing Address - Country:US
Mailing Address - Phone:775-329-2300
Mailing Address - Fax:775-329-5514
Practice Address - Street 1:5420 KIETZKE LN
Practice Address - Street 2:STE 103
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2063
Practice Address - Country:US
Practice Address - Phone:775-329-2300
Practice Address - Fax:775-329-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016568Medicaid
NVF81455Medicare UPIN
NV002016568Medicaid