Provider Demographics
NPI:1467948554
Name:CHUNG, REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
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 1:1309 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4245
Mailing Address - Country:US
Mailing Address - Phone:503-585-2022
Mailing Address - Fax:503-365-3832
Practice Address - Street 1:1309 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4245
Practice Address - Country:US
Practice Address - Phone:503-585-2022
Practice Address - Fax:503-365-3832
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4366ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist