Basic Information
| Provider Information | |||||||||
| NPI: | 1831322825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N PARK RD | ||||||||
| Address2: | APT 1250 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847720644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 752 S 25TH ST | ||||||||
| Address2: | EYELAND | ||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180425337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102533939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2009 | ||||||||
| LastUpdateDate: | 12/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 007476 | NY | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG002552 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.