Provider Demographics
NPI:1609997337
Name:KO, HEECHUNG (OD)
Entity Type:Individual
Prefix:
First Name:HEECHUNG
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 WELLINGTON WAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1385
Mailing Address - Country:US
Mailing Address - Phone:859-275-2030
Mailing Address - Fax:859-275-2130
Practice Address - Street 1:535 WELLINGTON WAY
Practice Address - Street 2:SUITE 160
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1385
Practice Address - Country:US
Practice Address - Phone:859-275-2030
Practice Address - Fax:859-275-2130
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1514DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist