Healthcare Provider Details

I. General information

NPI: 1366876310
Provider Name (Legal Business Name): HAIYING CHENG O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 MEDLOCK BRIDGE RD STE 104
JOHNS CREEK GA
30097-4434
US

IV. Provider business mailing address

10475 MEDLOCK BRIDGE RD STE 104
JOHNS CREEK GA
30097-4434
US

V. Phone/Fax

Practice location:
  • Phone: 404-293-5990
  • Fax:
Mailing address:
  • Phone: 404-293-5990
  • Fax: 678-482-0876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002778
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT002778
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT002778
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: