Provider Demographics
NPI:1548642507
Name:CHEUNG, TIFFANY (OD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CHEUNG
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 1:288 E LIVE OAK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5602
Mailing Address - Country:US
Mailing Address - Phone:626-446-3937
Mailing Address - Fax:626-689-2953
Practice Address - Street 1:288 E LIVE OAK AVE STE D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5602
Practice Address - Country:US
Practice Address - Phone:626-446-3937
Practice Address - Fax:626-689-2953
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist