Provider Demographics
NPI:1639392228
Name:BAO, YAQUN (OD)
Entity Type:Individual
Prefix:
First Name:YAQUN
Middle Name:
Last Name:BAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:YACHIN
Other - Middle Name:
Other - Last Name:BAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1730 WILLIAMS TRACE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4055
Mailing Address - Country:US
Mailing Address - Phone:281-491-2199
Mailing Address - Fax:281-491-2332
Practice Address - Street 1:1730 WILLIAMS TRACE BLVD STE J
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4055
Practice Address - Country:US
Practice Address - Phone:281-491-2199
Practice Address - Fax:281-491-2199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX6840TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z031OtherMEDICARE PTAN
TX00Z031OtherMEDICARE GROUP PTAN
TX8F7837OtherMEDICARE INDIVIDUAL PTAN
TXTX6840TGOtherLICENSE