Healthcare Provider Details

I. General information

NPI: 1477039097
Provider Name (Legal Business Name): RYAN JOSHUA YEUNG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4537 PARK CT
BELLAIRE TX
77401-3713
US

IV. Provider business mailing address

4537 PARK CT
BELLAIRE TX
77401-3713
US

V. Phone/Fax

Practice location:
  • Phone: 832-622-7448
  • Fax:
Mailing address:
  • Phone: 832-622-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9536T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: