Healthcare Provider Details

I. General information

NPI: 1548829823
Provider Name (Legal Business Name): YAN TING HUANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 DOUGLAS PKWY STE 54
ERIE PA
16509-7304
US

IV. Provider business mailing address

1930 DOUGLAS PKWY STE 54
ERIE PA
16509-7304
US

V. Phone/Fax

Practice location:
  • Phone: 814-844-6370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003524
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: