Provider Demographics
NPI:1528353943
Name:CHENG, LORRIE T (OD)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:T
Last Name:CHENG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LORRIE
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3185
Mailing Address - Fax:215-707-1684
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:ZONE C PARKINSON PAVILLION 6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3185
Practice Address - Fax:215-707-1684
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002382152W00000X
NJ27OA00625600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist