Provider Demographics
NPI:1215106745
Name:CHUNG, ANNE (OD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KILKENNY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M1W 1J5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 YONGE STREET
Practice Address - Street 2:4TH LEVEL
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M5B 2H1
Practice Address - Country:CA
Practice Address - Phone:416-971-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist