Healthcare Provider Details

I. General information

NPI: 1083474076
Provider Name (Legal Business Name): UTOPIA OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 UTOPIA PKWY
WHITESTONE NY
11357-4133
US

IV. Provider business mailing address

2003 UTOPIA PKWY
WHITESTONE NY
11357-4133
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-7352
  • Fax: 718-423-0930
Mailing address:
  • Phone: 718-353-7352
  • Fax: 718-423-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. GLORIA CHUNG
Title or Position: PRESIDENT
Credential: OD
Phone: 718-353-7352