Provider Demographics
NPI:1366580524
Name:DR. JOHN P.S. YU, O.D., P.A. AND ASSOCIATES
Entity type:Organization
Organization Name:DR. JOHN P.S. YU, O.D., P.A. AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSYCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-4449
Mailing Address - Street 1:4159 DOWLEN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6852
Mailing Address - Country:US
Mailing Address - Phone:409-899-4449
Mailing Address - Fax:409-899-1136
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4172TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0098DGOtherBLUE CROSS BLUE SHIELD
0098DGOtherBLUE CROSS BLUE SHIELD
00835TMedicare PIN