Provider Demographics
NPI:1528589017
Name:SOONG, KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:SOONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 MILL RUN BND
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2776
Mailing Address - Country:US
Mailing Address - Phone:412-913-6819
Mailing Address - Fax:512-918-2028
Practice Address - Street 1:3419 EL SALIDO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5639
Practice Address - Country:US
Practice Address - Phone:512-918-3937
Practice Address - Fax:512-918-2028
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003032152W00000X
TX9183-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT003032OtherGA OPTOMETRY LICENSE
TX9183-TGOtherTX OPTOMETRY LICENSE