Provider Demographics
NPI:1811022890
Name:YEE, ANGELA (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:YEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1820
Mailing Address - Country:US
Mailing Address - Phone:218-463-2020
Mailing Address - Fax:218-463-2055
Practice Address - Street 1:306 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1820
Practice Address - Country:US
Practice Address - Phone:218-463-2020
Practice Address - Fax:218-463-2055
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN192K5YEOtherBLUE CROSS BLUE SHIELD
MN192K5YEOtherBLUE CROSS BLUE SHIELD