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NPI Code Detail

MEDICARE: JING YE O.D.

MEDICARE: JING YE O.D.
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MO2865OTHERMOEYEMED

General Provider Information

NPI Number : 1811046626
Entity Type Code : Individual
Provider Name (Legal Business Name) : JING YE O.D.
Provider Business Mailing Address
First Line : 4121 BLACKJACK OAK DR
Second Line :
City : LAWRENCE
State : KS
Zip : 66047-1946
Country : US
Telephone Number : 785-856-2036
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 : 816-216-0001
Fax Number : 816-216-0013
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 01/25/2010

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