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General NPI Number Information
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NPI Number | 1427695550
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Entity Type | Organization
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Legal Business Name | ALLEN CHUNG OD OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 9460 MIRA MESA BLVD STE A
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City | SAN DIEGO
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State | CA
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Zip | 92126-4870
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Country | US
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Telephone | 858-566-1756
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Fax |
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Provider Business Mailing Address
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Address Line | 9460 MIRA MESA BLVD STE A
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City | SAN DIEGO
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State | CA
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Zip | 92126-4870
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Country | US
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Telephone | 858-566-1756
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLEN CHUNG
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Credential | O.D.
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Telephone | 858-566-1756
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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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