Provider Demographics
NPI:1477099257
Name:YAN, SHIRLEY (OD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:YAN
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 1:3191 CROW CANYON PL
Mailing Address - Street 2:STE C
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1349
Mailing Address - Country:US
Mailing Address - Phone:925-244-1400
Mailing Address - Fax:
Practice Address - Street 1:15051 HESPERIAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3536
Practice Address - Country:US
Practice Address - Phone:510-276-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33620 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist