Basic Information
| Provider Information | |||||||||
| NPI: | 1740453620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YEU-LIN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | Y | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LIN | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | YEU | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 241 CORPORATE BLVD. STE. 210 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576222200 | ||||||||
| FaxNumber: | 7579659493 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 CORPORATE BLVD | ||||||||
| Address2: | STE. 210 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576222200 | ||||||||
| FaxNumber: | 7579659493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 0101253475 | VA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1740453620 | 01 | VA | TRICARE/TRICARE FOR LIFE | OTHER | 489220 | 01 | VA | ANTHEM BCBS | OTHER | P01179585 | 01 | VA | RR MEDICARE | OTHER | 1740453620 | 05 | VA | MEDICAID | 10107980 | 01 | VA | OPTIMA | OTHER |