Provider Demographics
NPI:1558462143
Name:YEE, FERN (OD)
Entity Type:Individual
Prefix:DR
First Name:FERN
Middle Name:
Last Name:YEE
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 1:7209 CHIMNEY CORS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2156
Mailing Address - Country:US
Mailing Address - Phone:512-454-5117
Mailing Address - Fax:512-450-1496
Practice Address - Street 1:7209 CHIMNEY CORS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2156
Practice Address - Country:US
Practice Address - Phone:512-454-5117
Practice Address - Fax:512-450-1496
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10569152W00000X
TX7902T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1646556-01Medicaid
TX1646556-01Medicaid
TX8B4554Medicare ID - Type Unspecified