Healthcare Provider Details

I. General information

NPI: 1568962736
Provider Name (Legal Business Name): YANG EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5953 W PARK AVE STE 3000
HOUMA LA
70364-1422
US

IV. Provider business mailing address

1324 W ESPLANADE AVE APT B
KENNER LA
70065-4995
US

V. Phone/Fax

Practice location:
  • Phone: 985-879-4638
  • Fax:
Mailing address:
  • Phone: 612-298-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1602-635T
License Number StateLA

VIII. Authorized Official

Name: DR. CHUEMAI YANG
Title or Position: OWNER, OPTOMETRIST
Credential: OD
Phone: 612-298-7150