MEDICARE: DR. JOHNNY SUN OD

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	3997	MN

General Provider Information

NPI Number	:	1164917621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY SUN OD

Provider Business Mailing Address
First Line	:	1278 TOWN CENTRE DR STE 155
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-6404
Country	:	US
Telephone Number	:	612-851-0208
Fax Number	:	651-686-2940

Provider Business Practice Location Address
First Line	:	1278 TOWN CENTRE DR STE 155
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-6404
Country	:	US
Telephone Number	:	612-851-0208
Fax Number	:	651-686-2940

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	04/01/2026

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Directions to “ DR. JOHNNY SUN OD” Practice Location

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