Provider Demographics
NPI:1477716223
Name:CHENG, CHESTER C (OD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:C
Last Name:CHENG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 W WHITTIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3893
Mailing Address - Country:US
Mailing Address - Phone:562-694-2500
Mailing Address - Fax:562-694-2577
Practice Address - Street 1:121 W WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3893
Practice Address - Country:US
Practice Address - Phone:562-694-2500
Practice Address - Fax:562-694-2577
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH022XMedicare PIN