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General NPI Number Information
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NPI Number | 1407548670
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Entity Type | Organization
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Legal Business Name | MELISSA CHONG OD OPTOMETRY CORPORATION
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 410 S GLENDORA AVE STE 110
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City | GLENDORA
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State | CA
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Zip | 91741-6207
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Country | US
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Telephone | 626-335-4021
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 OAK AVE UNIT 895
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City | TEMPLE CITY
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State | CA
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Zip | 91780-4436
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MELISSA CHONG
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Credential |
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Telephone | 323-519-8237
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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 |
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License Number State |
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