Healthcare Provider Details

I. General information

NPI: 1760003073
Provider Name (Legal Business Name): WILLIAM GEWAH YEE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 08/27/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 TOWNE SQUARE BLVD NW
ROANOKE VA
24012-1611
US

IV. Provider business mailing address

10 CHURCH AVE SW APT 419
ROANOKE VA
24011-2026
US

V. Phone/Fax

Practice location:
  • Phone: 540-278-2880
  • Fax:
Mailing address:
  • Phone: 626-353-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002931
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: