Provider Demographics
NPI:1003902883
Name:CHAUNG, HENRY (OD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:CHAUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153A HESTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4740
Mailing Address - Country:US
Mailing Address - Phone:212-431-8446
Mailing Address - Fax:
Practice Address - Street 1:153A HESTER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4740
Practice Address - Country:US
Practice Address - Phone:212-431-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00941135Medicaid
NYC3W051, C46371Medicare ID - Type Unspecified
NY00941135Medicaid