Provider Demographics
NPI:1316020076
Name:CHUNG, TERESA (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
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 1:2618 4TH AVE N APT 501
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1959
Mailing Address - Country:US
Mailing Address - Phone:206-715-2926
Mailing Address - Fax:
Practice Address - Street 1:915 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4606
Practice Address - Country:US
Practice Address - Phone:206-789-8694
Practice Address - Fax:206-789-9629
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU92183Medicare UPIN