Provider Demographics
NPI:1801394739
Name:OH, WON
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 OLD YORK RD STE 220A
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3062
Mailing Address - Country:US
Mailing Address - Phone:215-635-2110
Mailing Address - Fax:
Practice Address - Street 1:7300 OLD YORK RD STE 220A
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3062
Practice Address - Country:US
Practice Address - Phone:215-635-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2019-12-09
Deactivation Date:2018-01-25
Deactivation Code:
Reactivation Date:2019-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician