Provider Demographics
NPI:1760003073
Name:YEE, WILLIAM GEWAH (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEWAH
Last Name:YEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHURCH AVE SW APT 419
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-2026
Mailing Address - Country:US
Mailing Address - Phone:626-353-1034
Mailing Address - Fax:
Practice Address - Street 1:1384 TOWNE SQUARE BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1611
Practice Address - Country:US
Practice Address - Phone:540-278-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0618002931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program