Healthcare Provider Details

I. General information

NPI: 1881728541
Provider Name (Legal Business Name): CAROLIN YEUNG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NE 137TH AVE
VANCOUVER WA
98682-4933
US

IV. Provider business mailing address

7101 NE 137TH AVE
VANCOUVER WA
98682-4933
US

V. Phone/Fax

Practice location:
  • Phone: 510-209-4456
  • Fax:
Mailing address:
  • Phone: 510-209-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3237AT
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT #13204T
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4146TX
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: