Provider Demographics
NPI:1063572865
Name:MIN, YOONGIE E (OD)
Entity type:Individual
Prefix:DR
First Name:YOONGIE
Middle Name:E
Last Name:MIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2200 W HENDERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7327
Practice Address - Country:US
Practice Address - Phone:614-273-2020
Practice Address - Fax:614-273-4335
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH4127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4311940001Medicare NSC
OH0645132Medicare PIN
OHU18517Medicare UPIN