Provider Demographics
NPI:1952378010
Name:CHUN, ALBERT K (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:K
Last Name:CHUN
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 1:3537 TORRANCE BLVD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4818
Mailing Address - Country:US
Mailing Address - Phone:310-543-3555
Mailing Address - Fax:310-540-8363
Practice Address - Street 1:3537 TORRANCE BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4818
Practice Address - Country:US
Practice Address - Phone:310-543-3555
Practice Address - Fax:310-540-8363
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8210T152W00000X, 152WV0400X
HI220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI220OtherSTATE OPTOMETRIC LICENSE
CA4827390001OtherMEDICARE DMEPOS
CASD0082100Medicaid
CA8210TOtherSTATE OPTOMETRIC LICENSE
CA4827390001OtherMEDICARE DMEPOS
CAT70257Medicare UPIN
CAOP8210Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER