Provider Demographics
NPI:1609177120
Name:YUN, MICHELLE GINAH (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GINAH
Last Name:YUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:GINAH
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1212 PARKSIDE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6951
Mailing Address - Country:US
Mailing Address - Phone:919-883-9987
Mailing Address - Fax:919-887-6381
Practice Address - Street 1:1212 PARKSIDE MAIN ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6951
Practice Address - Country:US
Practice Address - Phone:919-883-9987
Practice Address - Fax:919-887-6381
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist