Provider Demographics
NPI:1245368455
Name:YONG, PENNY Y (OD)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:Y
Last Name:YONG
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 1:323 MEADOW TRAIL CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7310
Mailing Address - Country:US
Mailing Address - Phone:901-759-1421
Mailing Address - Fax:901-754-6520
Practice Address - Street 1:7475 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2202
Practice Address - Country:US
Practice Address - Phone:901-754-8282
Practice Address - Fax:901-754-6520
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist