Provider Demographics
NPI:1164685194
Name:YAP, BRIAN R (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:YAP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 THORNDALE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4636
Mailing Address - Country:US
Mailing Address - Phone:323-605-2063
Mailing Address - Fax:888-769-4820
Practice Address - Street 1:2700 COLORADO BLVD STE 239
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1048
Practice Address - Country:US
Practice Address - Phone:323-258-2020
Practice Address - Fax:888-769-4820
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13481152W00000X
NY007498152W00000X
AZ001797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ150987OtherMEDICARE PTAN