Provider Demographics
NPI:1396094249
Name:BAE, VANIA YIP (OD)
Entity type:Individual
Prefix:
First Name:VANIA
Middle Name:YIP
Last Name:BAE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VANIA
Other - Middle Name:SHUI-YIN
Other - Last Name:YIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:50 PARK ROW W APT 312
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1145
Mailing Address - Country:US
Mailing Address - Phone:714-914-4554
Mailing Address - Fax:
Practice Address - Street 1:1404 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4841
Practice Address - Country:US
Practice Address - Phone:401-943-6000
Practice Address - Fax:401-943-6017
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14478 TLG152W00000X
MA5063152W00000X
RICODTG00674152W00000X
VA0618003289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist