MEDICARE: DR. WEON JUN 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	OPT 10765	CA
2	152W00000X	Optometrist	3252	WA
3	152W00000X	Optometrist	2514ATI	OR

General Provider Information

NPI Number	:	1811925134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WEON JUN O.D.

Provider Business Mailing Address
First Line	:	3710 SW US VETERANS HOSPITAL RD
Second Line	:	P-3-EYE
City	:	PORTLAND
State	:	OR
Zip	:	97239-2964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 NW LOVEJOY ST STE 750
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-3281
Country	:	US
Telephone Number	:	503-535-2883
Fax Number	:	503-535-2887

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	10/18/2023

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