Healthcare Provider Details

I. General information

NPI: 1972155620
Provider Name (Legal Business Name): FIONA YUAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 10/31/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-DZO 3551 ROGER BROOKE DRIVE
JBSA-FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-DZO 3551 ROGER BROOKE DRIVE
JBSA-FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-295-4335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100479
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: