Healthcare Provider Details

I. General information

NPI: 1154774792
Provider Name (Legal Business Name): GARY YAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL BEETHAM EYE INSTITUTE, JOSLIN DIABETES CENTER
BOSTON MA
02215-5306
US

IV. Provider business mailing address

1 JOSLIN PL BEETHAM EYE INSTITUTE, JOSLIN DIABETES CENTER
BOSTON MA
02215-5306
US

V. Phone/Fax

Practice location:
  • Phone: 617-309-2586
  • Fax: 617-309-2545
Mailing address:
  • Phone: 617-309-2586
  • Fax: 617-309-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number265945
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: