MEDICARE: DR. HELEN SONG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618002011	VA
2	152W00000X	Optometrist	27OA00628000	NJ

General Provider Information

NPI Number	:	1417251331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELEN SONG O.D.

Provider Business Mailing Address
First Line	:	4710 SPOTSYLVANIA PKWY
Second Line	:	SUITE 104
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9433
Country	:	US
Telephone Number	:	540-741-2733
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 SPOTSYLVANIA PKWY
Second Line	:	SUITE 104
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9433
Country	:	US
Telephone Number	:	540-741-2733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

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