Healthcare Provider Details

I. General information

NPI: 1689559817
Provider Name (Legal Business Name): YC CLEARLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SE SPINNAKER AVE
PORT SAINT LUCIE FL
34983-4038
US

IV. Provider business mailing address

1051 SE SPINNAKER AVE
PORT SAINT LUCIE FL
34983-4035
US

V. Phone/Fax

Practice location:
  • Phone: 954-906-2379
  • Fax:
Mailing address:
  • Phone: 786-253-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. YENISMAR CABRERA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 786-253-2607