Provider Demographics
NPI:1831322825
Name:CHUNG, KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
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 1:100 N PARK RD
Mailing Address - Street 2:APT 1250
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3044
Mailing Address - Country:US
Mailing Address - Phone:484-772-0644
Mailing Address - Fax:
Practice Address - Street 1:752 S 25TH ST
Practice Address - Street 2:EYELAND
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5337
Practice Address - Country:US
Practice Address - Phone:610-253-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007476152W00000X
PAOEG002552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist