Provider Demographics
NPI:1467472860
Name:UNG, CONNIE (OD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:UNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:11710 ORCHARD MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5514
Mailing Address - Country:US
Mailing Address - Phone:409-727-5366
Mailing Address - Fax:409-727-4910
Practice Address - Street 1:3100 HIGHWAY 365
Practice Address - Street 2:SUITE 164
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7724
Practice Address - Country:US
Practice Address - Phone:409-727-5366
Practice Address - Fax:409-727-4910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5283TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist