1811181787 NPI number — CHRISTOPHER YEAREGO, OD AND ASSOCIATES, PLLC

Table of content: DR. DANIEL ELLIOTT BUXTON M.D. (NPI 1790999845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811181787 NPI number — CHRISTOPHER YEAREGO, OD AND ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER YEAREGO, OD AND ASSOCIATES, PLLC
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:
Provider Other Organization Name Type Code:
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:
1811181787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 BEVERLY PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-9729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-637-5554
Provider Business Mailing Address Fax Number:
304-637-2666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 BEVERLY PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26241-9729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-637-5554
Provider Business Practice Location Address Fax Number:
304-637-2666
Provider Enumeration Date:
09/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YEAREGO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
304-637-5554

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  902 OD , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0149515000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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