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NPI Code Detail

MEDICARE: JING YE, OD., LLC

MEDICARE: JING YE, OD., LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2006022865MO

General Provider Information

NPI Number : 1720311566
Entity Type Code : Organization
Provider Name (Legal Business Name) : JING YE, OD., LLC
Provider Business Mailing Address
First Line : 4121 BLACKJACK OAK DR
Second Line :
City : LAWRENCE
State : KS
Zip : 66047-1946
Country : US
Telephone Number : 785-393-3622
Fax Number : 785-856-2036
Provider Business Practice Location Address
First Line : 241 E LINWOOD BLVD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-1119
Country : US
Telephone Number : 816-931-4515
Fax Number : 816-931-4515
Authorized Official
Title or Position : PRESIDENT
Name : DR. JING YE
Credential : O.D.
Telephone Number : 816-931-4515
Provider Enumeration Date : 09/11/2009
Last Update Date : 07/17/2015

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