Healthcare Provider Details

I. General information

NPI: 1780826933
Provider Name (Legal Business Name): CHUNG YIN YAU OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MOTT ST
NEW YORK NY
10013-4981
US

IV. Provider business mailing address

107 MOTT ST
NEW YORK NY
10013-4981
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8181
  • Fax: 212-941-8428
Mailing address:
  • Phone: 212-925-8181
  • Fax: 212-941-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number007048-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: