Provider Demographics
NPI:1508207531
Name:CHUNG, CHING MAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHING MAN
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 1:424 CUMBERLAND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1533
Mailing Address - Country:US
Mailing Address - Phone:347-387-7367
Mailing Address - Fax:
Practice Address - Street 1:273 ELTINGVILLE BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2447
Practice Address - Country:US
Practice Address - Phone:917-554-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist