Healthcare Provider Details

I. General information

NPI: 1558462143
Provider Name (Legal Business Name): FERN YEE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 W KOENIG LN
AUSTIN TX
78756-1416
US

IV. Provider business mailing address

1518 W KOENIG LN
AUSTIN TX
78756-1416
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-5117
  • Fax: 512-450-1496
Mailing address:
  • Phone: 512-454-5117
  • Fax: 512-450-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10569
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7902TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: