MEDICARE: IAN S. JUNG 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	OPC3127	FL

General Provider Information

NPI Number	:	1558339994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN S. JUNG OD

Provider Business Mailing Address
First Line	:	11025 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-5049
Country	:	US
Telephone Number	:	352-683-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	11025 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-5049
Country	:	US
Telephone Number	:	352-683-3937
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	10/24/2008

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