Provider Demographics
NPI:1730230400
Name:YEO, GEOFFREY ALAN (OD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ALAN
Last Name:YEO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 FOX HILLS MALL
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6402
Mailing Address - Country:US
Mailing Address - Phone:310-390-2142
Mailing Address - Fax:310-397-5306
Practice Address - Street 1:192 FOX HILLS MALL
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6402
Practice Address - Country:US
Practice Address - Phone:310-390-2142
Practice Address - Fax:310-397-5306
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA12021T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91714Medicare UPIN
CASDO120210Medicare ID - Type Unspecified