MEDICARE: DR. HEIDI YING OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV006127	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	RA0624	OTHER	NY	UPSTATE MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	598900	OTHER	MVP
2	0679800001	OTHER	DME REGION A
3	10043432	OTHER	CDPHP

General Provider Information

NPI Number	:	1588651434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI YING OD

Provider Business Mailing Address
First Line	:	157 FRONT ST
Second Line	:
City	:	VESTAL
State	:	NY
Zip	:	13850-1511
Country	:	US
Telephone Number	:	607-754-4426
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 FRONT ST
Second Line	:
City	:	VESTAL
State	:	NY
Zip	:	13850-1511
Country	:	US
Telephone Number	:	607-754-4426
Fax Number	:	607-754-0464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	01/27/2022

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Directions to “ DR. HEIDI YING OD” Practice Location

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