Healthcare Provider Details

I. General information

NPI: 1689725970
Provider Name (Legal Business Name): ANH Q CHUNG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/22/2011
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 TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2579
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: