Provider Demographics
NPI:1871636472
Name:JUNG, JENA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENA
Middle Name:MARIE
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 1:45330 ABELL HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-3203
Mailing Address - Country:US
Mailing Address - Phone:301-863-6080
Mailing Address - Fax:
Practice Address - Street 1:45330 ABELL HOUSE LN
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3203
Practice Address - Country:US
Practice Address - Phone:301-863-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2155152W00000X
VA0618001492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2155OtherMARYLAND OPTOMETRY LICENSE