Healthcare Provider Details

I. General information

NPI: 1326498593
Provider Name (Legal Business Name): RICHARD WILKINS YEMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 TANGLEFOOT LN
BETTENDORF IA
52722-1650
US

IV. Provider business mailing address

777 TANGLEFOOT LN
BETTENDORF IA
52722-1650
US

V. Phone/Fax

Practice location:
  • Phone: 563-323-2020
  • Fax: 563-328-5699
Mailing address:
  • Phone: 563-459-6676
  • Fax: 563-459-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036152654
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL 0006167
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number47090
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: