Provider Demographics
NPI:1194876151
Name:YU, JOHN PS (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PS
Last Name:YU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:4159 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6852
Practice Address - Country:US
Practice Address - Phone:409-899-4449
Practice Address - Fax:409-899-1136
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4172TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80185QOtherBLUE CROSS BLUE SHIELD
TX4172OtherEYEMED
19039OtherSPECTERA
42836OtherDAVIS VISION
8664B7Medicare ID - Type Unspecified
TX80185QOtherBLUE CROSS BLUE SHIELD