Healthcare Provider Details

I. General information

NPI: 1053978122
Provider Name (Legal Business Name): YANARA BARRERAS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 BILL BECK BLVD
KISSIMMEE FL
34744-9516
US

IV. Provider business mailing address

1503 BILL BECK BLVD
KISSIMMEE FL
34744-9516
US

V. Phone/Fax

Practice location:
  • Phone: 407-943-8600
  • Fax: 407-932-5150
Mailing address:
  • Phone: 407-943-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPC5644
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5644
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC5644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: