MEDICARE: DR. HYEJON KO, P.A.

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	152WC0802X	Corneal and Contact Management Optometrist	4991T	TX

General Provider Information

NPI Number	:	1700074879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. HYEJON KO, P.A.

Provider Business Mailing Address
First Line	:	6121 W PARK BLVD
Second Line	:	STE D-120
City	:	PLANO
State	:	TX
Zip	:	75093-6221
Country	:	US
Telephone Number	:	972-202-5632
Fax Number	:	972-202-5630

Provider Business Practice Location Address
First Line	:	6121 W PARK BLVD
Second Line	:	STE D-120
City	:	PLANO
State	:	TX
Zip	:	75093-6221
Country	:	US
Telephone Number	:	972-202-5632
Fax Number	:	972-202-5630

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HYEJON KO
Credential	:	OD
Telephone Number	:	972-862-8080

Provider Enumeration Date	:	10/14/2007
Last Update Date	:	10/14/2007

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