MEDICARE: NATALIYA A YAKOVLEVA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC5194	FL

General Provider Information

NPI Number	:	1164872230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIYA A YAKOVLEVA OD

Provider Business Mailing Address
First Line	:	7840 GATE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7277
Country	:	US
Telephone Number	:	904-503-4108
Fax Number	:	904-035-7153

Provider Business Practice Location Address
First Line	:	7840 GATE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7277
Country	:	US
Telephone Number	:	904-503-4801
Fax Number	:	904-503-7153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	11/03/2021

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