Healthcare Provider Details

I. General information

NPI: 1396897013
Provider Name (Legal Business Name): CHUNG EYE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E. WALNUT
PARIS AR
72855
US

IV. Provider business mailing address

P.O. BOX 647
PARIS AR
72855
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-2661
  • Fax: 479-963-6821
Mailing address:
  • Phone: 479-963-2661
  • Fax: 479-963-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2579
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN H CHUNG
Title or Position: CHAIRMAN
Credential: OD
Phone: 479-963-2661