Healthcare Provider Details

I. General information

NPI: 1740803766
Provider Name (Legal Business Name): ANTHONY CHI-KWONG CHIANG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 STATE ROUTE 28
MILFORD OH
45150-4940
US

IV. Provider business mailing address

PO BOX 207170
DALLAS TX
75320-7156
US

V. Phone/Fax

Practice location:
  • Phone: 513-831-3166
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1001
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3572
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.7001
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: