Provider Demographics
NPI:1437767167
Name:BYUN, IRENE (OD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BYUN
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 1:183 MOTT ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4597
Mailing Address - Country:US
Mailing Address - Phone:614-209-6032
Mailing Address - Fax:
Practice Address - Street 1:183 MOTT ST APT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4597
Practice Address - Country:US
Practice Address - Phone:614-209-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist