Healthcare Provider Details

I. General information

NPI: 1831016609
Provider Name (Legal Business Name): MAN YI GAO OD
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: JOYCE GAO

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 86TH ST
BROOKLYN NY
11228-3429
US

IV. Provider business mailing address

1452 86TH ST
BROOKLYN NY
11228-3429
US

V. Phone/Fax

Practice location:
  • Phone: 718-265-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: