Provider Demographics
NPI:1821562422
Name:SOPHIA K YANG, O.D, PLC
Entity Type:Organization
Organization Name:SOPHIA K YANG, O.D, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-848-6051
Mailing Address - Street 1:12233 WOODSIDE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1643
Mailing Address - Country:US
Mailing Address - Phone:312-848-6051
Mailing Address - Fax:
Practice Address - Street 1:1016 S STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1904
Practice Address - Country:US
Practice Address - Phone:810-653-3206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty