Provider Demographics
NPI:1023022209
Name:CHEUNG, MYLYNN (OD)
Entity type:Individual
Prefix:DR
First Name:MYLYNN
Middle Name:
Last Name:CHEUNG
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 1:7408 STREAM WALK LN.
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109
Mailing Address - Country:US
Mailing Address - Phone:703-368-5557
Mailing Address - Fax:703-330-7659
Practice Address - Street 1:7412 STREAM WALK LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2464
Practice Address - Country:US
Practice Address - Phone:703-368-5557
Practice Address - Fax:703-330-7659
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist