Provider Demographics
NPI:1144236829
Name:CHUNG, WENDY (OD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CHUNG
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 1:1450 W GRAND PKWY S # G-285
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8286
Mailing Address - Country:US
Mailing Address - Phone:832-623-6169
Mailing Address - Fax:
Practice Address - Street 1:1450 W GRAND PKWY S # G-285
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8286
Practice Address - Country:US
Practice Address - Phone:832-623-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06632T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184624801Medicaid
TX184624801Medicaid