JISOO SONG OD
NPI 1407556921
Optometrist in Herndon, VA
About Jisoo Song Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JISOO SONG OD (NPI 1407556921) is an individual optometrist in Herndon, Virginia, licensed in Virginia (0618003230) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jisoo Song Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jisoo Song reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Herndon, VA 20170
- Reassigned Medicare billing, District of Columbia and Virginia enrollments
- Also billed through NPI 1639067861 (Virginia)
- 202 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20170 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jisoo Song's NPI number?
The NPI number for Jisoo Song is 1407556921. It was assigned to this individual provider in the NPPES registry on March 3, 2023.
Where is Jisoo Song located?
Jisoo Song practices at 709 Pine St, Herndon, VA 20170. The listed phone number is (703) 471-7810.
What is Jisoo Song's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Jisoo Song enrolled in Medicare?
Yes. Jisoo Song is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jisoo Song's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jisoo Song reassigns Medicare benefits to Myeyedr Optometry Of Virginia, PLLC (Herndon, VA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jisoo Song's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jisoo Song accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 8 other insurers list Jisoo Song as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jisoo Song was last updated on November 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jisoo Song, OD · NPI 1407556921
Optometrist provider in Herndon, Virginia. Individual provider, active in the CMS NPPES registry since March 3, 2023.
## Identity
- **NPI:** 1407556921 (Entity type: Individual)
- **Enumerated:** March 3, 2023
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** 0618003230 (Virginia)
- **Sole proprietor:** No
## Practice location
- **Address:** 709 PINE ST, Herndon, VA 20170-4604
- **Phone:** (703) 471-7810 · **Fax:** (703) 471-6549
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Myeyedr Optometry Of Virginia, PLLC (NPI 1265198071, Herndon, VA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** November 25, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1407556921) · Data from the CMS NPPES public registry.