Provider Demographics
NPI:1275674293
Name:SONG, JULIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
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 1:106 ERICA DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8463
Mailing Address - Country:US
Mailing Address - Phone:248-917-3618
Mailing Address - Fax:
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:#455
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2455
Practice Address - Country:US
Practice Address - Phone:509-736-0733
Practice Address - Fax:509-783-6259
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60111027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist