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General NPI Number Information
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NPI Number | 1508754615
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Entity Type | Individual
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Provider Name | JINSEON JEONG OD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 5040 STATE HIGHWAY 121 STE 400B
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City | LEWISVILLE
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State | TX
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Zip | 75056-2610
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Country | US
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Telephone | 469-284-0173
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Fax | 469-322-9933
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Provider Business Mailing Address
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Address Line | 5040 STATE HIGHWAY 121 STE 400B
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City | LEWISVILLE
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State | TX
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Zip | 75056-2610
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Country | US
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Telephone | 469-284-0173
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Fax | 469-322-9933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11477TG
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License Number State | TX
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