Provider Demographics
NPI:1821190141
Name:CHONG, LANCE M (OD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:M
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 1:2930 S 1ST ST STE 700
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-3452
Mailing Address - Country:US
Mailing Address - Phone:972-278-0154
Mailing Address - Fax:972-278-8327
Practice Address - Street 1:2930 S 1ST ST STE 700
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3452
Practice Address - Country:US
Practice Address - Phone:972-278-0154
Practice Address - Fax:972-278-8327
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5771TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019139702Medicaid
TX019139702Medicaid