Basic Information
| Provider Information | |||||||||
| NPI: | 1417911363 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | EUNJUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9505 STEELE ST S | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984446858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535976800 | ||||||||
| FaxNumber: | 2535976888 | ||||||||
| Practice Location | |||||||||
| Address1: | 2914 S ALDER ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984094819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532729245 | ||||||||
| FaxNumber: | 2532729413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2006 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OD00004014 | WA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 3985872 | 01 | WA | CIGNA | OTHER | QMP000003361514 | 01 | WA | MOLINA | OTHER | 1016897 | 01 | WA | COVENTRY HEALTH CARE | OTHER | 2032522 | 05 | WA | MEDICAID | 1016897 | 01 | WA | FIRST HEALTH | OTHER | P00407154 | 01 | WA | RAILROAD MEDICARE | OTHER | 749912 | 01 | WA | AETNA | OTHER | 216087 | 01 | WA | LABOR & INDUSTRIES | OTHER | OD409WA | 01 | AK | ALASKA MEDICAID | OTHER |