Provider Demographics
NPI:1407220585
Name:CHENG, JUDY (OD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:CHENG
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 1:4440 S US HIGHWAY 41 STE 102
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4409
Mailing Address - Country:US
Mailing Address - Phone:812-232-2988
Mailing Address - Fax:
Practice Address - Street 1:4440 S US HIGHWAY 41 STE 102
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4409
Practice Address - Country:US
Practice Address - Phone:812-232-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2011DT152W00000X
IN18004228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist