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General NPI Number Information
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NPI Number | 1730443060
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Entity Type | Individual
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Provider Name | GRACE YOON OD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 4550 E CACTUS RD #30
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City | PHOENIX
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State | AZ
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Zip | 85032-7711
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Country | US
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Telephone | 602-485-1300
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Fax | 602-494-1029
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Provider Business Mailing Address
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Address Line | 14405 W COLFAX AVE #310
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City | LAKEWOOD
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State | CO
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Zip | 80401-3247
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Country | US
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Telephone | 303-215-0376
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Fax | 303-302-6906
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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 | 1856
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License Number State | AZ
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