Healthcare Provider Details

I. General information

NPI: 1497733729
Provider Name (Legal Business Name): BRIAN MICHAEL YEE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 W 10TH ST
TRACY CA
95376-3902
US

IV. Provider business mailing address

36 W 10TH ST
TRACY CA
95376-3902
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-7446
  • Fax: 209-835-3572
Mailing address:
  • Phone: 209-835-7446
  • Fax: 209-835-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: