Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA2112 | MD |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA2112 | MD |
NPI | 1235395575 |
---|---|
Provider Name | Hannah Y Song |
First Address | Fairfax, VA 22031-1357 |
Second Address | Fairfax, VA 22031-1357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2008 |
Last Update Date | 04/01/2021 |