Provider Demographics
NPI:1821068149
Name:JUNG, BARBARA L (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
Last Name:JUNG
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 1:1080 S WHITE RD
Mailing Address - Street 2:RD. #A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3821
Mailing Address - Country:US
Mailing Address - Phone:408-272-3002
Mailing Address - Fax:408-272-0820
Practice Address - Street 1:1080 S WHITE RD
Practice Address - Street 2:RD. #A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3821
Practice Address - Country:US
Practice Address - Phone:408-272-3002
Practice Address - Fax:408-272-0820
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7237T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000230Medicaid
CASDO072370Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAGSD000230Medicaid