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, and ordering and referring status from the CMS PECOS system.
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.
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.
What insurance does Jisoo Song accept?
Health plans from Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana and Oscar Health Maintenance Organization of Florida 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 8 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
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** November 25, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1407556921) · Data from the CMS NPPES public registry.