=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790098705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XIAOYIN SUN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2010
-----------------------------------------------------
Last Update Date | 02/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 MARKET ST SUITE 920
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-2096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-799-1219
-----------------------------------------------------
Fax | 609-799-1235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 MARKET ST STE 402
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-2080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-799-1219
-----------------------------------------------------
Fax | 609-799-1235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00626100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------