Provider Demographics
NPI:1083669626
Name:CHUN, RANDALL R (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:R
Last Name:CHUN
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 1:1874 N PLACENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870
Mailing Address - Country:US
Mailing Address - Phone:714-996-3937
Mailing Address - Fax:714-996-3938
Practice Address - Street 1:1874 N PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-996-3937
Practice Address - Fax:714-996-3938
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10681T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0106810Medicaid
CABZ128ZMedicare PIN
CA5450540001Medicare NSC
U69617Medicare UPIN