Provider Demographics
NPI:1780679431
Name:CHONG, RICHARD J (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:CHONG
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 1:1833 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2838
Mailing Address - Country:US
Mailing Address - Phone:415-362-2000
Mailing Address - Fax:415-362-7520
Practice Address - Street 1:1833 POWELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2838
Practice Address - Country:US
Practice Address - Phone:415-362-2000
Practice Address - Fax:415-362-7520
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6632T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0066320Medicaid
CASD0066320Medicaid
CADK717AMedicare PIN
CA0478680001Medicare NSC