Provider Demographics
NPI:1639211154
Name:KO, HYEJON (OD)
Entity Type:Individual
Prefix:DR
First Name:HYEJON
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 1:2624 PRESTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8892
Mailing Address - Country:US
Mailing Address - Phone:972-862-8080
Mailing Address - Fax:
Practice Address - Street 1:6121 W PARK BLVD STE D120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6232
Practice Address - Country:US
Practice Address - Phone:972-202-5632
Practice Address - Fax:972-202-5630
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4991-T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management