Healthcare Provider Details

I. General information

NPI: 1184542870
Provider Name (Legal Business Name): SAMUEL YOON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MIAMISBURG CENTERVILLE RD STE 1268
DAYTON OH
45459-3735
US

IV. Provider business mailing address

2700 MIAMISBURG CENTERVILLE RD STE 1268
DAYTON OH
45459-3735
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: