Provider Demographics
NPI:1730215286
Name:CHEUNG, LAURA WAI SUM (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:WAI SUM
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 1:2225 GREER CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5214
Mailing Address - Country:US
Mailing Address - Phone:510-494-8838
Mailing Address - Fax:510-494-9588
Practice Address - Street 1:39492 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2117
Practice Address - Country:US
Practice Address - Phone:510-494-8838
Practice Address - Fax:510-494-9588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11822T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0118220Medicaid
CA11822TOtherCALIFORNIA LICENSE NUMBER
CASD11822TOOtherBLUE SHIELD OF CALIFORNIA
CASD0118220Medicaid