Healthcare Provider Details

I. General information

NPI: 1346643327
Provider Name (Legal Business Name): DIANA CHUONG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W GIRARD AVE 5
PHILADELPHIA PA
19123-1660
US

IV. Provider business mailing address

180 W GIRARD AVE 5
PHILADELPHIA PA
19123-1660
US

V. Phone/Fax

Practice location:
  • Phone: 215-554-6222
  • Fax: 215-554-6200
Mailing address:
  • Phone: 215-554-6222
  • Fax: 215-554-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003009
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: