MEDICARE: CHUNG YONG SONG OD

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	VUT005241	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VUT005241	OTHER	NY	OPTOMETRIC LICENSE

General Provider Information

NPI Number	:	1588637987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUNG YONG SONG OD

Provider Business Mailing Address
First Line	:	1323 ECHO HILL PATH
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598
Country	:	US
Telephone Number	:	914-962-7455
Fax Number	:	212-967-2101

Provider Business Practice Location Address
First Line	:	901 SIXTH AVENUE
Second Line	:	HERALD SQUARE OPTOMETRIC ASSOCIATES PC
City	:	NEW YORK CITY
State	:	NY
Zip	:	10001
Country	:	US
Telephone Number	:	212-967-4177
Fax Number	:	212-967-2101

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	03/14/2008

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Directions to “ CHUNG YONG SONG OD” Practice Location

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