Healthcare Provider Details

I. General information

NPI: 1700074879
Provider Name (Legal Business Name): DR. HYEJON KO, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2007
Last Update Date: 10/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 W PARK BLVD STE D-120
PLANO TX
75093-6221
US

IV. Provider business mailing address

6121 W PARK BLVD STE D-120
PLANO TX
75093-6221
US

V. Phone/Fax

Practice location:
  • Phone: 972-202-5632
  • Fax: 972-202-5630
Mailing address:
  • Phone: 972-202-5632
  • Fax: 972-202-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4991T
License Number StateTX

VIII. Authorized Official

Name: DR. HYEJON KO
Title or Position: OWNER
Credential: OD
Phone: 972-862-8080