Provider Demographics
NPI:1043763667
Name:LOOK STORE
Entity Type:Organization
Organization Name:LOOK STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUYEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-562-4087
Mailing Address - Street 1:16800 CENTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11160 VEIRS MILL RD
Practice Address - Street 2:TARGET OPTICAL
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2538
Practice Address - Country:US
Practice Address - Phone:352-562-4087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-31
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073878476OtherOPTOMETRIST