Provider Demographics
NPI:1497889992
Name:TUNG, JU YUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:JU YUNG
Middle Name:
Last Name:TUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:TUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:16020 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1612
Mailing Address - Country:US
Mailing Address - Phone:708-614-6849
Mailing Address - Fax:708-614-6864
Practice Address - Street 1:16020 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1612
Practice Address - Country:US
Practice Address - Phone:708-614-6849
Practice Address - Fax:708-614-6864
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0460009552Medicaid