Provider Demographics
NPI:1548458102
Name:MA, CHUNFENG (OD)
Entity type:Individual
Prefix:
First Name:CHUNFENG
Middle Name:
Last Name:MA
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 1:4037 IVEYGLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4224
Mailing Address - Country:US
Mailing Address - Phone:407-373-3298
Mailing Address - Fax:
Practice Address - Street 1:145 S ORLANDO AVE
Practice Address - Street 2:ROYAL PLAZA, SUITE 12
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5692
Practice Address - Country:US
Practice Address - Phone:407-644-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist