MEDICARE: DR. EDWIN JEUNG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1094	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	C40373	OTHER	CO	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1094	OTHER	CO	COLORADO LIC. #

General Provider Information

NPI Number	:	1033109483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN JEUNG O.D.

Provider Business Mailing Address
First Line	:	1044 S 88TH ST STE 109
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9418
Country	:	US
Telephone Number	:	303-666-0104
Fax Number	:	303-666-6844

Provider Business Practice Location Address
First Line	:	1044 S 88TH ST STE 109
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9418
Country	:	US
Telephone Number	:	303-666-0104
Fax Number	:	303-666-6844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/21/2012

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Directions to “ DR. EDWIN JEUNG O.D.” Practice Location

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