Provider Demographics
NPI:1417251331
Name:SONG, HELEN (OD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
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 1:4710 SPOTSYLVANIA PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9433
Mailing Address - Country:US
Mailing Address - Phone:540-741-2733
Mailing Address - Fax:
Practice Address - Street 1:4710 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9433
Practice Address - Country:US
Practice Address - Phone:540-741-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002011152W00000X
NJ27OA00628000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist