Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2596 | NC |
NPI | 1013556133 |
---|---|
Provider Name | Mao Yang |
First Address | Lexington, KY 40504-3226 |
Second Address | Lexington, KY 40511-1052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 06/01/2020 |