MEDICARE: RONI SUNG 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	046009352	IL

General Provider Information

NPI Number	:	1588743132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONI SUNG OD

Provider Business Mailing Address
First Line	:	7742 KILBOURN AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3653
Country	:	US
Telephone Number	:	773-301-8115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 W TOUHY AVE STE D01D
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2721
Country	:	US
Telephone Number	:	847-673-3902
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	11/15/2022

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