Provider Demographics
NPI:1881639441
Name:YUAN, JESSICA (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:YUAN
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 1:1183 E FOOTHILL BLVD
Mailing Address - Street 2:#140
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4049
Mailing Address - Country:US
Mailing Address - Phone:909-608-0601
Mailing Address - Fax:909-608-0610
Practice Address - Street 1:1183 E FOOTHILL BLVD
Practice Address - Street 2:#140
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4049
Practice Address - Country:US
Practice Address - Phone:909-608-0601
Practice Address - Fax:909-608-0610
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0109450Medicare PIN