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NPI Code Detail

MEDICARE: NELLIE CHUNG OD

MEDICARE: NELLIE CHUNG OD
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
1152W00000XOptometristOD60961378WA
2152W00000XOptometristATI4496OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ATI4496OTHEROROR STATE LICENSE

General Provider Information

NPI Number : 1588216519
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELLIE CHUNG OD
Provider Business Mailing Address
First Line : 1046 NW JOHNSON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97209
Country : US
Telephone Number : 503-944-5567
Fax Number : 503-944-5471
Provider Business Practice Location Address
First Line : 1046 NW JOHNSON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3161
Country : US
Telephone Number : 503-944-5567
Fax Number : 503-944-5471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2019
Last Update Date : 05/07/2023

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Directions to “ NELLIE CHUNG OD” Practice Location

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