Provider Demographics
NPI:1891925459
Name:YU, WAY (OD)
Entity Type:Individual
Prefix:
First Name:WAY
Middle Name:
Last Name:YU
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 1:22 SUMMERHILL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3814
Mailing Address - Country:US
Mailing Address - Phone:415-785-7730
Mailing Address - Fax:
Practice Address - Street 1:110 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3947
Practice Address - Country:US
Practice Address - Phone:510-235-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE491ZOtherPTAN
CA1891925459OtherNPI
CAP00862867Medicare PIN