Healthcare Provider Details

I. General information

NPI: 1457080145
Provider Name (Legal Business Name): ANDREW S YAN RDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 WASHINGTON ST
SAN FRANCISCO CA
94108-1310
US

IV. Provider business mailing address

746 WASHINGTON ST
SAN FRANCISCO CA
94108-1310
US

V. Phone/Fax

Practice location:
  • Phone: 415-984-1960
  • Fax:
Mailing address:
  • Phone: 415-984-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL004199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: