Provider Demographics
NPI:1124046248
Name:YEH, GLENDY (OD)
Entity Type:Individual
Prefix:
First Name:GLENDY
Middle Name:
Last Name:YEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:2929 TURNER HILL RD
Practice Address - Street 2:2625
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2500
Practice Address - Country:US
Practice Address - Phone:770-482-5050
Practice Address - Fax:770-482-5706
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT1001907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU84026Medicare UPIN