Provider Demographics
NPI:1306683560
Name:WAH, YI-KWEN NICOLLE (OD)
Entity type:Individual
Prefix:
First Name:YI-KWEN
Middle Name:NICOLLE
Last Name:WAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:
Other - Last Name:WAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2041 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2041 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3203
Practice Address - Country:US
Practice Address - Phone:718-266-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist