=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992969109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHEUNG G LAW OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2008
-----------------------------------------------------
Last Update Date | 08/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 LEHIGH VALLEY MALL PEARLE VISION
-----------------------------------------------------
City | WHITEHALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18052-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-264-8537
-----------------------------------------------------
Fax | 610-264-8417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 LEHIGH VALLEY MALL PEARLE VISION
-----------------------------------------------------
City | WHITEHALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18052-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-264-8537
-----------------------------------------------------
Fax | 610-264-8417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG002071
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------