MEDICARE: DR. HYEJON KO 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	4991-T	TX
2	152WC0802X	Corneal and Contact Management Optometrist	4991-T	TX

General Provider Information

NPI Number	:	1639211154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYEJON KO O.D.

Provider Business Mailing Address
First Line	:	2624 PRESTONWOOD DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8892
Country	:	US
Telephone Number	:	972-862-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 W PARK BLVD STE D120
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6232
Country	:	US
Telephone Number	:	972-202-5632
Fax Number	:	972-202-5630

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	09/11/2025

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