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General NPI Number Information
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NPI Number | 1891840195
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Entity Type | Individual
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Provider Name | SUSAN CHEUNG O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 12672 LIMONITE AVE SUITE 3F
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City | CORONA
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State | CA
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Zip | 92880-4201
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Country | US
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Telephone | 951-582-9090
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Fax | 951-582-9991
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Provider Business Mailing Address
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Address Line | 6610 BLACK FOREST DR
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City | CORONA
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State | CA
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Zip | 92880-3921
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Country | US
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Telephone | 951-582-9090
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11463T
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License Number State | CA
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