Provider Demographics
NPI:1841555273
Name:JUNG, KURT R (OD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:R
Last Name:JUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5536
Mailing Address - Country:US
Mailing Address - Phone:901-728-5858
Mailing Address - Fax:901-531-6312
Practice Address - Street 1:650 NEW YORK ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5536
Practice Address - Country:US
Practice Address - Phone:901-728-5858
Practice Address - Fax:901-531-6312
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist