Individual
NELLIE CHUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1046 NW JOHNSON ST, PORTLAND, OR 97209-3161
(503) 944-5567
(503) 944-5471
Mailing address
1046 NW JOHNSON ST, PORTLAND, OR 97209
(503) 944-5567
(503) 944-5471
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ATI4496
OR
152W00000X
Optometrist
OD60961378
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ATI4496
OR STATE LICENSE
OR
Enumeration date
07/10/2019
Last updated
05/07/2023
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