Healthcare Provider Details

I. General information

NPI: 1659629384
Provider Name (Legal Business Name): YEN'S OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 LINCOLN AVE
SAN JOSE CA
95125-3022
US

IV. Provider business mailing address

1335 LINCOLN AVE.
SAN JOSE CA
95125
US

V. Phone/Fax

Practice location:
  • Phone: 812-327-1426
  • Fax:
Mailing address:
  • Phone: 812-327-1426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number12476
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number12476
License Number StateCA

VIII. Authorized Official

Name: DR. LUCY YEN
Title or Position: DOCTOR OF OPTOMETRY
Credential: OD
Phone: 812-327-1426