Provider Demographics
NPI:1447561915
Name:YUTANG SU MD PLLC
Entity Type:Organization
Organization Name:YUTANG SU MD PLLC
Other - Org Name:VALLEY VITREORETINAL CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUTANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-271-4719
Mailing Address - Street 1:2103 E GRIFFIN PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3490
Mailing Address - Country:US
Mailing Address - Phone:956-271-4719
Mailing Address - Fax:956-271-4717
Practice Address - Street 1:2103 E GRIFFIN PKWY STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3490
Practice Address - Country:US
Practice Address - Phone:956-271-4719
Practice Address - Fax:956-271-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217350201Medicaid
TXTXB108422Medicare PIN
TXF86739Medicare UPIN