Healthcare Provider Details

I. General information

NPI: 1255126009
Provider Name (Legal Business Name): KEEL YEUNG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MOTT ST STE 408
NEW YORK NY
10013-5588
US

IV. Provider business mailing address

128 MOTT ST STE 408
NEW YORK NY
10013-5588
US

V. Phone/Fax

Practice location:
  • Phone: 212-732-0073
  • Fax:
Mailing address:
  • Phone: 212-732-0073
  • Fax: 212-732-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011428
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: