MEDICARE: GAINESVILLE EYE ASSOCIATES, LLC

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	207W00000X	Ophthalmology Physician	0101239485	VA

General Provider Information

NPI Number	:	1356518849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAINESVILLE EYE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	7300 HERITAGE VILLAGE PLZ
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	703-753-4733
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 HERITAGE VILLAGE PLZ
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	703-753-4733
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILIP RYONG CHUNG
Credential	:	M.D.
Telephone Number	:	703-753-4733

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/14/2008

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