Provider Demographics
NPI:1225841190
Name:JING YANG VISION SOURCE INC
Entity type:Organization
Organization Name:JING YANG VISION SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANG
Authorized Official - Middle Name:
Authorized Official - Last Name:JING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:857-384-0312
Mailing Address - Street 1:4111 PARSONS BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4111 PARSONS BLVD APT 505
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1900
Practice Address - Country:US
Practice Address - Phone:857-384-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty