Provider Demographics
NPI:1790835197
Name:DR. JERRY K. YEANG
Entity type:Organization
Organization Name:DR. JERRY K. YEANG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:YEANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-993-3388
Mailing Address - Street 1:6500 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE #17
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4055
Mailing Address - Country:US
Mailing Address - Phone:361-993-3388
Mailing Address - Fax:361-993-3388
Practice Address - Street 1:6500 S PADRE ISLAND DR
Practice Address - Street 2:SUITE #17
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4055
Practice Address - Country:US
Practice Address - Phone:361-993-3388
Practice Address - Fax:361-993-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3407TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00E13CMedicare PIN
T16771Medicare UPIN