Provider Demographics
NPI:1073616983
Name:JUNG, STEVE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 COBURG ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-338-4844
Mailing Address - Fax:541-338-4849
Practice Address - Street 1:207 COBURG RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-338-4844
Practice Address - Fax:541-338-4849
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2808 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298545Medicaid
OR298545Medicaid
OR113003Medicare ID - Type Unspecified