Individual provider Active NPI

Myung H Jung, OD

  • Optometrist
  • Chehalis, WA
National Provider Identifier
1750636726
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD60394858 Issued in WA
Practice address
2517 NE Kresky Ave
Chehalis, WA 98532-2409
Phone
(360) 748-8632
Fax
(360) 748-3869
NPI assigned
Jul 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD60394858 WA Primary
Optometrist 152W00000X AT3523 OR
Optometrist 152W00000X 007851 NY
Optometrist 152W00000X 27OA00642700 NJ
Optometrist 152W00000X 3523AT OR

Addresses

Primary practice location

2517 NE Kresky Ave
Chehalis, WA 98532-2409

Mailing address

PO Box 1506
Chehalis, WA 98532-0409
Phone (360) 242-3008

Other identifiers 2

IdentifierTypeStateIssuer
1750636726MedicaidOR
2060397MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address myung.jung.p1@direct.pcli.nextgenshare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20131212001304 OR Practitioner - Optometry 5496982738 Reassigns benefits to 1 organization
I20160614001714 WA Practitioner - Optometry 5496982738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Cataract and Laser Institute Inc PCGroup PAC ID 7517864119, shared by 15 NPIs, 75 clinicians

Practice addresses (Care Compare)

1331 NW Lovejoy St
Suite 750
Portland, OR 97209-2799
Phone (503) 535-2883

2517 NE Kresky Ave
Chehalis, WA 98532-2433
Phone (360) 748-8632

9309 NE 86TH St
Vancouver, WA 98662-2100
Phone (360) 694-2544

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27OA00642700NJMDOptometrist
007851NYMDOptometrist
AT3523ORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Cataract and Laser Institute Inc PC CurrentSince May 9, 2016 Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. Current Accepting new patients
Pacific Cataract and Laser Institute Inc PC Current Accepting new patients
Pacific Cataract and Laser Institute Inc PC Current Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. CurrentSince May 9, 2016 Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. CurrentSince May 9, 2016 Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. Past Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. Past Accepting new patients

Locations

1331 NW Lovejoy St
Ste 750
Portland, OR 97209
Phone (503) 535-2883

19801 SW 72nd Ave
Ste 150
Tualatin, OR 97062
Phone (503) 691-2283

2606 116th Ave NE
Ste 100
Bellevue, WA 98004
Phone (425) 462-7664

4330 Mitchell Way
Bellingham, WA 98226
Phone (360) 736-6860

2517 NE Kresky Ave
Chehalis, WA 98532
Phone (360) 748-8632

6695 W Rio Grande Ave
Kennewick, WA 99336
Phone (509) 736-0826

115 New View Ct NE
Olympia, WA 98506
Phone (360) 252-1642

9598 Mickelberry Rd NW
Silverdale, WA 98383
Phone (360) 698-5062

16818 E Desmet Ct
Spokane Valley, WA 99216
Phone (360) 242-3008

2915 S Alder St
Tacoma, WA 98409
Phone (253) 473-0275

2205 NE 129th St
Vancouver, WA 98686
Phone (360) 450-6644

3900 Kern Rd
Yakima, WA 98902
Phone (509) 966-1356

Organizations & group practices 8

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": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1750636726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1506",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985320409",
            "telephone_number": "360-242-3008",
            "fax_number": "360-807-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2517 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322409",
            "telephone_number": "360-748-8632",
            "fax_number": "360-748-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNG",
        "first_name": "MYUNG",
        "middle_name": "H",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60394858",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "AT3523",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "007851",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00642700",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3523AT",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750636726",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2060397",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "myung.jung.p1@direct.pcli.nextgenshare.com",
            "affiliation": "N",
            "address_1": "2517 NE Kresky Ave",
            "city": "Chehalis",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985322409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chehalis, WA

Sources for this page

Verify at the official NPI Registry.