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General NPI Number Information
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NPI Number | 1902087414
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Entity Type | Individual
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Provider Name | LISA CHUNG OD
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Gender | Female
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 310 BARBER CT
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City | MILPITAS
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State | CA
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Zip | 95035-7922
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Country | US
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Telephone | 408-342-8101
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Fax | 408-432-8103
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Provider Business Mailing Address
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Address Line | 1603 FAIRWAY GREEN CIR
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City | SAN JOSE
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State | CA
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Zip | 95131-3211
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Country | US
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Telephone | 408-453-8425
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Fax | 408-318-2743
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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 | OPT 13096 TPA
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License Number State | CA
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