Provider Demographics
NPI:1356869317
Name:LOOK STORE
Entity type:Organization
Organization Name:LOOK STORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUYEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-562-4087
Mailing Address - Street 1:16800 CENTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2031
Mailing Address - Country:US
Mailing Address - Phone:352-562-4087
Mailing Address - Fax:
Practice Address - Street 1:12000 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1985
Practice Address - Country:US
Practice Address - Phone:301-572-6769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOOK STORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073878476OtherOPTOMETRIST