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NPI Code Detail

MEDICARE: DR. JOSEPH JAE UK MYUNG O.D.

MEDICARE: DR. JOSEPH JAE UK MYUNG 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
1152W00000XOptometrist046010122IL

General Provider Information

NPI Number : 1861656183
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH JAE UK MYUNG O.D.
Provider Business Mailing Address
First Line : 9531 S CICERO AVE
Second Line : 33
City : OAK LAWN
State : IL
Zip : 60453-3136
Country : US
Telephone Number : 708-423-2020
Fax Number :
Provider Business Practice Location Address
First Line : 9531 S CICERO AVE
Second Line : 33
City : OAK LAWN
State : IL
Zip : 60453-3136
Country : US
Telephone Number : 708-423-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2008
Last Update Date : 07/16/2008

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