Provider Demographics
NPI:1821214040
Name:SEONGMIN YOUN, OD. PC
Entity Type:Organization
Organization Name:SEONGMIN YOUN, OD. PC
Other - Org Name:THE EYEPLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONGMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-332-0200
Mailing Address - Street 1:42921 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5035
Mailing Address - Country:US
Mailing Address - Phone:248-332-0200
Mailing Address - Fax:
Practice Address - Street 1:42921 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5035
Practice Address - Country:US
Practice Address - Phone:248-332-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU-75098Medicare UPIN
MI0N56020Medicare ID - Type Unspecified