Provider Demographics
NPI:1750417994
Name:AHN, ALEX SUNGDO (OD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:SUNGDO
Last Name:AHN
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 1:22101 NE 10TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6863
Mailing Address - Country:US
Mailing Address - Phone:425-836-3065
Mailing Address - Fax:
Practice Address - Street 1:13550 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7512
Practice Address - Country:US
Practice Address - Phone:206-417-6920
Practice Address - Fax:206-417-6923
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3428TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist