Healthcare Provider Details

I. General information

NPI: 1376427088
Provider Name (Legal Business Name): JIYOUNG CHUN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E LEE ST
ENTERPRISE AL
36330-2011
US

IV. Provider business mailing address

820 E LEE ST
ENTERPRISE AL
36330-2011
US

V. Phone/Fax

Practice location:
  • Phone: 334-393-2020
  • Fax: 334-393-6936
Mailing address:
  • Phone: 334-393-2020
  • Fax: 334-393-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F75-TA-D74
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: