Provider Demographics
NPI:1245406842
Name:SUH, JUNG (OD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:SUH
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 1:8278 JAMES MADISON HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3818
Mailing Address - Country:US
Mailing Address - Phone:540-351-0125
Mailing Address - Fax:
Practice Address - Street 1:8278 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3818
Practice Address - Country:US
Practice Address - Phone:540-351-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist