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General NPI Number Information
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NPI Number | 1265641328
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Entity Type | Individual
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Provider Name | VIENGSAMAY J CHAMLEUNSOUK
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 601-635 HARRY L DR STERLING OPTICAL
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City | JOHNSON CITY
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State | NY
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Zip | 13790
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Country | US
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Telephone | 607-729-9179
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Fax |
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Provider Business Mailing Address
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Address Line | 864 RIVERSIDE DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1824
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Country | US
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Telephone | 607-770-8580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | 0083201
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License Number State | NY
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