Provider Demographics
NPI:1811901275
Name:YOON, SUN J (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:SUN
Middle Name:J
Last Name:YOON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6232
Mailing Address - Country:US
Mailing Address - Phone:201-592-6241
Mailing Address - Fax:201-592-1184
Practice Address - Street 1:2500 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6232
Practice Address - Country:US
Practice Address - Phone:201-592-6241
Practice Address - Fax:201-592-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1240156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5595890001Medicare ID - Type Unspecified