Healthcare Provider Details

I. General information

NPI: 1255377040
Provider Name (Legal Business Name): DAVID P YESNICK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 W FLAMINGO RD STE 120
LAS VEGAS NV
89147-6859
US

IV. Provider business mailing address

9191 W FLAMINGO RD STE 120
LAS VEGAS NV
89147-6859
US

V. Phone/Fax

Practice location:
  • Phone: 702-966-2020
  • Fax: 702-966-2022
Mailing address:
  • Phone: 702-966-2020
  • Fax: 702-966-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number335
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number335
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: