Healthcare Provider Details

I. General information

NPI: 1780722264
Provider Name (Legal Business Name): MR. MASTON JOHN YEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34393 PLYMOUTH RD
LIVONIA MI
48150-1539
US

IV. Provider business mailing address

34393 PLYMOUTH RD
LIVONIA MI
48150-1539
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-6500
  • Fax: 734-522-6510
Mailing address:
  • Phone: 734-522-6500
  • Fax: 734-522-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: