Provider Demographics
NPI:1043524283
Name:YI, ANNA SOYOUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:SOYOUNG
Last Name:YI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2024 WILMA RUDOLPH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6879
Mailing Address - Country:US
Mailing Address - Phone:931-551-3031
Mailing Address - Fax:931-552-7488
Practice Address - Street 1:5323 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2308
Practice Address - Country:US
Practice Address - Phone:615-731-8900
Practice Address - Fax:615-731-8990
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2941OtherSTATE LICENSE
TN2941OtherSTATE LICENSE