Provider Demographics
NPI:1346643327
Name:CHUONG, DIANA (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHUONG
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 1:180 W GIRARD AVE
Mailing Address - Street 2:5
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1660
Mailing Address - Country:US
Mailing Address - Phone:215-554-6222
Mailing Address - Fax:215-554-6200
Practice Address - Street 1:180 W GIRARD AVE
Practice Address - Street 2:5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1660
Practice Address - Country:US
Practice Address - Phone:215-554-6222
Practice Address - Fax:215-554-6200
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist