Healthcare Provider Details

I. General information

NPI: 1619089323
Provider Name (Legal Business Name): JACQUELINE H. TUNG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 E HILLSDALE BLVD SUITE B1
FOSTER CITY CA
94404-2112
US

IV. Provider business mailing address

967 E HILLSDALE BLVD SUITE B1
FOSTER CITY CA
94404-2112
US

V. Phone/Fax

Practice location:
  • Phone: 650-286-1388
  • Fax: 650-268-8645
Mailing address:
  • Phone: 650-286-1388
  • Fax: 650-268-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12743TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: