Provider Demographics
NPI:1750819785
Name:W WINSTON YAO OD PC
Entity Type:Organization
Organization Name:W WINSTON YAO OD PC
Other - Org Name:COMMUNITY OPTICCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:W. WINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-682-8588
Mailing Address - Street 1:410 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1214
Mailing Address - Country:US
Mailing Address - Phone:978-682-8588
Mailing Address - Fax:
Practice Address - Street 1:410 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1214
Practice Address - Country:US
Practice Address - Phone:978-682-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110013249Medicaid