Provider Demographics
NPI:1649299678
Name:CHUN, BETTY P (OD)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:P
Last Name:CHUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1907 SALEROSO DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4116
Mailing Address - Country:US
Mailing Address - Phone:626-253-0405
Mailing Address - Fax:
Practice Address - Street 1:10123 N WOLFE RD STE 2144
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2513
Practice Address - Country:US
Practice Address - Phone:408-446-4004
Practice Address - Fax:408-446-9195
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12558T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist