Individual provider Active NPI

Yung Su, O.D.

  • Optometrist
  • Austin, TX
National Provider Identifier
1245611565
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8654T Issued in TX
Practice address
1030 Norwood Park Blvd Ste a
Austin, TX 78753-6606
Phone
(512) 491-9707
NPI assigned
Jun 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8654T TX Primary

Addresses

Primary practice location

1030 Norwood Park Blvd Ste a
Austin, TX 78753-6606

Mailing address

1030 Norwood Park Blvd Ste a
Austin, TX 78753-6606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151208001559 TX Practitioner - Optometry 5092015461 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8654TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Family Vision Optometrist CurrentSince Nov 1, 2015 Accepting new patients

Locations

1030 Norwood Park Blvd
Ste A
Austin, TX 78753
Phone (512) 491-9707

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433980800000",
    "number": "1245611565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 NORWOOD PARK BLVD STE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787536606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 NORWOOD PARK BLVD STE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787536606",
            "telephone_number": "512-491-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "YUNG",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8654T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.