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NPI Code Detail

MEDICARE: DR. TODD M YACKELS O.D.

MEDICARE:  DR. TODD M YACKELS  O.D.
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
1152W00000XOptometrist2479-035WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235190109
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD M YACKELS O.D.
Provider Business Mailing Address
First Line : 1221 COBBLESTONE PL
Second Line :
City : WEST BEND
State : WI
Zip : 53095-4585
Country : US
Telephone Number : 262-335-2902
Fax Number :
Provider Business Practice Location Address
First Line : 2950 S CHASE AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-6407
Country : US
Telephone Number : 414-483-1092
Fax Number : 414-483-1095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2006
Last Update Date : 07/08/2007

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Directions to “ DR. TODD M YACKELS O.D.” Practice Location

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