Provider Demographics
NPI:1649363128
Name:YIN, JOHN QIANG (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:QIANG
Last Name:YIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:QIANG
Other - Middle Name:
Other - Last Name:YIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4034 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6044
Mailing Address - Country:US
Mailing Address - Phone:718-886-8858
Mailing Address - Fax:718-886-8897
Practice Address - Street 1:4034 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6044
Practice Address - Country:US
Practice Address - Phone:718-886-8858
Practice Address - Fax:718-886-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52661OtherDAVIS VISION
NY02680871Medicaid
NYNY6920OtherEYEMED VISIONCARE
NYNY6920OtherEYEMED VISIONCARE