Provider Demographics
NPI:1659387520
Name:YANG, IRENE LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:LEE
Last Name:YANG
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:VA PUGET SOUND HEALTH CARE SYSTEM
Mailing Address - Street 2:BLIND REHAB CENTER (A-112-BRC)
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:253-583-1236
Mailing Address - Fax:253-589-4112
Practice Address - Street 1:VA PUGET SOUND HEALTH CARE SYSTEM
Practice Address - Street 2:BLIND REHAB CENTER (A-112-BRC)
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1236
Practice Address - Fax:253-589-4112
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA3050152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU50051Medicare UPIN