Provider Demographics
NPI:1528595550
Name:CHARLES SUNG MD PC
Entity Type:Organization
Organization Name:CHARLES SUNG MD PC
Other - Org Name:RETINA LASER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-736-5550
Mailing Address - Street 1:317 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7750
Mailing Address - Country:US
Mailing Address - Phone:509-736-5550
Mailing Address - Fax:509-737-8281
Practice Address - Street 1:317 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7750
Practice Address - Country:US
Practice Address - Phone:509-736-5550
Practice Address - Fax:509-737-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854419OtherMEDICARE GROUP ID-TYPE UNSPECIFIED
WA1729120Medicaid