Provider Demographics
NPI:1538596671
Name:SUK, DONG CHAN (OD)
Entity type:Individual
Prefix:DR
First Name:DONG
Middle Name:CHAN
Last Name:SUK
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 1:115 BEECHNUT ST
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1542
Mailing Address - Country:US
Mailing Address - Phone:858-204-7724
Mailing Address - Fax:
Practice Address - Street 1:99 SIDNEY ST
Practice Address - Street 2:EYE CLINIC
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist