MEDICARE: DR. ESTHER CHUNG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WL0500X	Low Vision Rehabilitation Optometrist	13244T	CA

General Provider Information

NPI Number	:	1356598288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESTHER CHUNG O.D.

Provider Business Mailing Address
First Line	:	11707 W SUNSET BLVD APT 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-2945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1011
Country	:	US
Telephone Number	:	818-243-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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