MEDICARE: DR. JAMES P CHEUNG OPTOMETRIST

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	11619 TPL	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1780734152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES P CHEUNG OPTOMETRIST

Provider Business Mailing Address
First Line	:	4141 S NOGALES ST
Second Line	:	BUILDING C UNIT 101
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3056
Country	:	US
Telephone Number	:	626-839-1010
Fax Number	:	626-839-1013

Provider Business Practice Location Address
First Line	:	4141 S NOGALES ST
Second Line	:	BUILDING C UNIT 101
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3056
Country	:	US
Telephone Number	:	626-839-1010
Fax Number	:	626-839-1013

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	05/26/2016

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