Healthcare Provider Details

I. General information

NPI: 1215106745
Provider Name (Legal Business Name): ANNE CHUNG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 YONGE STREET 4TH LEVEL
TORONTO ONTARIO
M5B 2H1
CA

IV. Provider business mailing address

19 KILKENNY DRIVE
SCARBOROUGH ONTARIO
M1W 1J5
CA

V. Phone/Fax

Practice location:
  • Phone: 416-971-8355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: