Provider Demographics
NPI:1407958424
Name:YEH, LILY (OD)
Entity Type:Individual
Prefix:DR
First Name:LILY
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 1:139 HAZARD AVE
Mailing Address - Street 2:BLDG 1
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-749-1233
Mailing Address - Fax:860-749-4613
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BLDG 1
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-749-1233
Practice Address - Fax:860-749-4613
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004101292Medicaid
U02917Medicare UPIN
CT004101292Medicaid