Provider Demographics
NPI:1730277419
Name:YUAN, REINA (OD)
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:YUAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REINA
Other - Middle Name:YUAN
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:939 EDGEWATER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3760
Mailing Address - Country:US
Mailing Address - Phone:650-573-6245
Mailing Address - Fax:650-573-1466
Practice Address - Street 1:939 EDGEWATER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-3760
Practice Address - Country:US
Practice Address - Phone:650-573-6245
Practice Address - Fax:650-573-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH87311Medicare UPIN