Provider Demographics
NPI:1508858820
Name:YAN, EVA (OD)
Entity Type:Individual
Prefix:
First Name:EVA
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 1:25 WESTCHESTER SQ
Mailing Address - Street 2:METRO OPTICS EYEWEAR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3545
Mailing Address - Country:US
Mailing Address - Phone:718-597-6162
Mailing Address - Fax:718-597-6168
Practice Address - Street 1:25 WESTCHESTER SQ
Practice Address - Street 2:METRO OPTICS EYEWEAR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3545
Practice Address - Country:US
Practice Address - Phone:718-597-6162
Practice Address - Fax:718-597-6168
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004217-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00740390Medicaid
NY00740390Medicaid
NYC3320WQ621Medicare PIN
NYC33201Medicare PIN
NYC33202Medicare PIN
NYT49092Medicare UPIN
NYA400077952Medicare PIN