Provider Demographics
NPI:1629207543
Name:JUANG, NING JU (OD)
Entity Type:Individual
Prefix:DR
First Name:NING JU
Middle Name:
Last Name:JUANG
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 1:303 W OHIO ST APT 3307
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7974
Mailing Address - Country:US
Mailing Address - Phone:347-553-5639
Mailing Address - Fax:
Practice Address - Street 1:303 W OHIO ST APT 3307
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7974
Practice Address - Country:US
Practice Address - Phone:347-553-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist