Healthcare Provider Details

I. General information

NPI: 1619238540
Provider Name (Legal Business Name): ASHLEY NICOLE YEARLING O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ASHLEY NICOLE HIGHT

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S WASHINGTON ST
MARION IN
46953-1961
US

IV. Provider business mailing address

1817 COLONIAL DR
ROCHESTER IN
46975-8958
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-6648
  • Fax:
Mailing address:
  • Phone: 765-210-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: