Provider Demographics
NPI:1831287671
Name:CHUNG, RANDALL L (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18181 BUTTERFIELD BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2897
Mailing Address - Country:US
Mailing Address - Phone:408-779-2000
Mailing Address - Fax:408-778-2569
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 150
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2897
Practice Address - Country:US
Practice Address - Phone:408-779-2000
Practice Address - Fax:408-778-2569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7938 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist