Provider Demographics
NPI:1760817233
Name:CHING, JULIE KELLYE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KELLYE
Last Name:CHING
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 1:731 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1026
Mailing Address - Country:US
Mailing Address - Phone:510-418-1557
Mailing Address - Fax:
Practice Address - Street 1:1556 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5100
Practice Address - Country:US
Practice Address - Phone:510-438-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist