Provider Demographics
NPI:1417025867
Name:CHEUNG, WING KIN (OD)
Entity Type:Individual
Prefix:DR
First Name:WING
Middle Name:KIN
Last Name:CHEUNG
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 1:855 72ND STREET 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 ELIZABETH ST
Practice Address - Street 2:PACIFIC OPTOMETRY, P.C.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4992
Practice Address - Country:US
Practice Address - Phone:212-219-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006136-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02277907Medicaid
NYU92019Medicare UPIN
NYC216F1Medicare ID - Type Unspecified