MEDICARE: DR. NAE HYON KWON 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	046009464	IL

General Provider Information

NPI Number	:	1306886932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAE HYON KWON O.D.

Provider Business Mailing Address
First Line	:	2120 E GRAND AVE
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9030
Country	:	US
Telephone Number	:	847-356-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 E GRAND AVE
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9030
Country	:	US
Telephone Number	:	847-356-2900
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/25/2008

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