Provider Demographics
NPI:1578135356
Name:YOON, PETER HEESUNG (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:HEESUNG
Last Name:YOON
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 1:435 MAIN ST APT 550
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6046
Mailing Address - Country:US
Mailing Address - Phone:858-386-8380
Mailing Address - Fax:
Practice Address - Street 1:348 BROAD AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1703
Practice Address - Country:US
Practice Address - Phone:201-592-8989
Practice Address - Fax:201-944-1620
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009362152W00000X, 152WC0802X
CAOPT34890-TLG152W00000X, 152WC0802X
NJ27OA00706500152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management