Individual provider Active NPI

Yueran Yan, OD

  • Optometrist
  • Dedham, MA
National Provider Identifier
1497307193
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5345 Issued in MA
Practice address
200 Legacy Blvd
Dedham, MA 02026-2653
Phone
(617) 651-6662
NPI assigned
Jul 12, 2019
Last updated
Mar 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5345 MA Primary

Addresses

Primary practice location

200 Legacy Blvd
Dedham, MA 02026-2653

Mailing address

200 Legacy Blvd
Dedham, MA 02026-2653
Phone (617) 651-6662

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230531001658 MA Practitioner - Optometry 8325405780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

200 Legacy Blvd
Dedham, MA 02026-2653
Phone (617) 651-6662

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5345MAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Eye Blink LLC Optometrist CurrentSince Apr 19, 2023 Accepting new patients

Locations

200 Legacy Blvd
Dedham, MA 02026
Phone (617) 651-6662

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1497307193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LEGACY BLVD",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020262653",
            "telephone_number": "617-651-6662",
            "fax_number": "781-459-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 LEGACY BLVD",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020262653",
            "telephone_number": "617-651-6662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAN",
        "first_name": "YUERAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-12",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dedham, MA

Sources for this page

Verify at the official NPI Registry.