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General NPI Number Information
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NPI Number | 1275719957
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Entity Type | Organization
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Legal Business Name | STEVE PHUNG OPTOMETRY INC
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Dates
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Enumeration Date | 01/13/2008
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 11412 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90606-3122
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Country | US
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Telephone | 562-908-0510
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Fax | 562-908-0511
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Provider Business Mailing Address
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Address Line | 11412 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90606-3122
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Country | US
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Telephone | 562-908-0510
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Fax | 562-908-0511
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVE PHUNG
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Credential | O.D.
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Telephone | 562-908-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11097T
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License Number State | CA
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