Provider Demographics
NPI:1689725970
Name:CHUNG, ANH Q (OD)
Entity Type:Individual
Prefix:DR
First Name:ANH
Middle Name:Q
Last Name:CHUNG
Suffix:
Gender:M
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:P.O. BOX 647
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855
Mailing Address - Country:US
Mailing Address - Phone:479-963-2661
Mailing Address - Fax:479-963-6821
Practice Address - Street 1:25 E. WALNUT
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855
Practice Address - Country:US
Practice Address - Phone:479-963-2661
Practice Address - Fax:479-963-6821
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181100722Medicaid