Provider Demographics
NPI:1497307193
Name:YAN, YUERAN (OD)
Entity Type:Individual
Prefix:DR
First Name:YUERAN
Middle Name:
Last Name:YAN
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 1:200 LEGACY BLVD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2653
Mailing Address - Country:US
Mailing Address - Phone:617-651-6662
Mailing Address - Fax:781-459-7990
Practice Address - Street 1:200 LEGACY BLVD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2653
Practice Address - Country:US
Practice Address - Phone:617-651-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist