1700276656 NPI number — YEALY EYE, LLC

Table of content: (NPI 1700276656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700276656 NPI number — YEALY EYE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YEALY EYE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YEALY EYE CARE AND DRY EYE CENTER OF LANCASTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700276656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
244 N QUEEN ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-735-0746
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 N QUEEN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-735-0746
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
YEALY
Authorized Official First Name:
NATALIA
Authorized Official Middle Name:
GORDILLO
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
786-512-5469

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WL0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1029995600001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com