Provider Demographics
NPI:1588637987
Name:SONG, CHUNG YONG (OD)
Entity Type:Individual
Prefix:
First Name:CHUNG
Middle Name:YONG
Last Name:SONG
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 1:1323 ECHO HILL PATH
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598
Mailing Address - Country:US
Mailing Address - Phone:914-962-7455
Mailing Address - Fax:212-967-2101
Practice Address - Street 1:901 SIXTH AVENUE
Practice Address - Street 2:HERALD SQUARE OPTOMETRIC ASSOCIATES PC
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-967-4177
Practice Address - Fax:212-967-2101
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVUT005241OtherOPTOMETRIC LICENSE
U65318Medicare UPIN
NYVUT005241OtherOPTOMETRIC LICENSE