Provider Demographics
NPI:1386853158
Name:CHO, HYONG J (OD)
Entity Type:Individual
Prefix:DR
First Name:HYONG
Middle Name:J
Last Name:CHO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25574 DAPPER CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6318
Mailing Address - Country:US
Mailing Address - Phone:571-215-1346
Mailing Address - Fax:703-631-5132
Practice Address - Street 1:13059 FAIRLAKE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-631-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist