MEDICARE: CHU YONG JEONG 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	5481	OH
2	152W00000X	Optometrist	2249	CO

General Provider Information

NPI Number	:	1750554002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHU YONG JEONG O.D.

Provider Business Mailing Address
First Line	:	5001 S. PARKER RD
Second Line	:	SUITE 204
City	:	AURORA
State	:	CO
Zip	:	80015
Country	:	US
Telephone Number	:	720-507-7004
Fax Number	:	720-507-7009

Provider Business Practice Location Address
First Line	:	5001 S PARKER RD STE 204
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1183
Country	:	US
Telephone Number	:	720-507-7004
Fax Number	:	720-570-7009

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	07/21/2022

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