Provider Demographics
NPI:1669640512
Name:MEDICAL AND SURGICAL EYE SPECIALIST, PLLC
Entity Type:Organization
Organization Name:MEDICAL AND SURGICAL EYE SPECIALIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RUMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-886-8318
Mailing Address - Street 1:4235 MAIN ST
Mailing Address - Street 2:3D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3956
Mailing Address - Country:US
Mailing Address - Phone:718-886-8318
Mailing Address - Fax:718-559-4815
Practice Address - Street 1:4235 MAIN ST
Practice Address - Street 2:3D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3956
Practice Address - Country:US
Practice Address - Phone:718-886-8318
Practice Address - Fax:929-667-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206272207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777417Medicaid
NY01777417Medicaid
G51485Medicare UPIN
NY89T292Medicare PIN