Provider Demographics
NPI:1629105341
Name:CHUNG, SEBI (OD)
Entity Type:Individual
Prefix:DR
First Name:SEBI
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19702 RANCH MDWS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3824
Mailing Address - Country:US
Mailing Address - Phone:210-659-2526
Mailing Address - Fax:210-657-7205
Practice Address - Street 1:6035 NW LOOP 410 STE A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3301
Practice Address - Country:US
Practice Address - Phone:210-509-4779
Practice Address - Fax:210-680-3438
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5772T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist