Provider Demographics
NPI:1235395575
Name:SONG, HANNAH Y (OD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:Y
Last Name:SONG
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 1:2700 POTOMAC MILLS CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4625
Mailing Address - Country:US
Mailing Address - Phone:703-492-1008
Mailing Address - Fax:703-492-1008
Practice Address - Street 1:2700 POTOMAC MILLS CIR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4625
Practice Address - Country:US
Practice Address - Phone:703-492-1008
Practice Address - Fax:703-492-1008
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2112152WC0802X, 152W00000X
VA0618002474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management