Provider Demographics
NPI:1972748184
Name:YOO, SUNG (OD)
Entity type:Individual
Prefix:MR
First Name:SUNG
Middle Name:
Last Name:YOO
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 1:81 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4510
Mailing Address - Country:US
Mailing Address - Phone:631-255-6429
Mailing Address - Fax:
Practice Address - Street 1:349 INDEPENDENCE PLZ
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2400
Practice Address - Country:US
Practice Address - Phone:631-736-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007314-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist