Healthcare Provider Details

I. General information

NPI: 1457024721
Provider Name (Legal Business Name): JASPER CHENG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 07/31/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8519 IRVINE CENTER DR
IRVINE CA
92618-4298
US

IV. Provider business mailing address

51 GOLDEN GLEN ST
IRVINE CA
92604-2455
US

V. Phone/Fax

Practice location:
  • Phone: 949-585-9403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: