Healthcare Provider Details

I. General information

NPI: 1770154049
Provider Name (Legal Business Name): YUAN OPTOMETRY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22015 AVALON BLVD STE A
CARSON CA
90745-3355
US

IV. Provider business mailing address

22015 AVALON BLVD STE A
CARSON CA
90745-3355
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-7584
  • Fax: 310-830-5856
Mailing address:
  • Phone: 310-830-7584
  • Fax: 310-830-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN YUAN
Title or Position: PRESIDENT
Credential: OD
Phone: 310-830-7584