Individual
LINDA HYUNAE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4105 BRIARGATE PKWY STE 125, COLORADO SPRINGS, CO 80920-3482
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
(303) 338-4545
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2646
CO
152W00000X
Optometrist
OPT11216TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2646
STATE LICENSE
CO
01
—
OPT11216TPA
STATE LICENSE NUMBER
CA
Enumeration date
08/20/2006
Last updated
04/07/2021
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