Provider Demographics
NPI:1235198631
Name:UNG, LYLY (OD)
Entity Type:Individual
Prefix:DR
First Name:LYLY
Middle Name:
Last Name:UNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3403
Mailing Address - Country:US
Mailing Address - Phone:415-585-6588
Mailing Address - Fax:415-585-6403
Practice Address - Street 1:940 GENEVA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3403
Practice Address - Country:US
Practice Address - Phone:415-585-6588
Practice Address - Fax:415-585-6403
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10244TPL152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0102441Medicaid
SD0102441Medicare ID - Type Unspecified