Provider Demographics
NPI:1780641423
Name:YAO, WENSHENG WINSTON (OD)
Entity Type:Individual
Prefix:DR
First Name:WENSHENG
Middle Name:WINSTON
Last Name:YAO
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 1:67 SHERBURNE RD S
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7060
Mailing Address - Country:US
Mailing Address - Phone:617-308-4018
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4171152W00000X
NH0694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313840Medicaid
NHRE6077Medicare ID - Type Unspecified
U83730Medicare UPIN
MA0313840Medicaid