MEDICARE: STEVE PHUNG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11097T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AV936Y	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144212713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE PHUNG O.D.

Provider Business Mailing Address
First Line	:	11412 WASHINGTON BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-3122
Country	:	US
Telephone Number	:	562-908-0510
Fax Number	:	562-908-0511

Provider Business Practice Location Address
First Line	:	11412 WASHINGTON BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-3122
Country	:	US
Telephone Number	:	562-908-0510
Fax Number	:	562-908-0511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	06/30/2009

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