Provider Demographics
NPI:1396897013
Name:CHUNG EYE CARE, PA
Entity type:Organization
Organization Name:CHUNG EYE CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-963-2661
Mailing Address - Street 1:P.O. BOX 647
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855
Mailing Address - Country:US
Mailing Address - Phone:479-963-2661
Mailing Address - Fax:479-963-6821
Practice Address - Street 1:25 E. WALNUT
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855
Practice Address - Country:US
Practice Address - Phone:479-963-2661
Practice Address - Fax:479-963-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2579152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159554722Medicaid
AR5F412OtherBLUE CROSS BLUE SHIELD
AR5F412Medicare PIN
AR159554722Medicaid