Provider Demographics
NPI:1235660705
Name:JASON CHEUNG, OD, LLC
Entity Type:Organization
Organization Name:JASON CHEUNG, OD, LLC
Other - Org Name:GARDEN CITY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-731-1564
Mailing Address - Street 1:519 BORDEN AVE APT 9L
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5899
Mailing Address - Country:US
Mailing Address - Phone:917-731-1564
Mailing Address - Fax:
Practice Address - Street 1:519 BORDEN AVE APT 9L
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5899
Practice Address - Country:US
Practice Address - Phone:917-731-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-25
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty