=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174012587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C EDWARD YEE MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2018
-----------------------------------------------------
Last Update Date | 05/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2451 W HORIZON RIDGE PKWY
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-362-3937
-----------------------------------------------------
Fax | 702-362-7935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2980 S JONES BLVD SUITE A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-5657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-362-3937
-----------------------------------------------------
Fax | 702-362-7935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | TANYA HUFFMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-362-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | NV7830
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------