Healthcare Provider Details

I. General information

NPI: 1508833260
Provider Name (Legal Business Name): RENEE D. YEARWOOD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE 7TH FLOOR, EYE CLINIC
BRONX NY
10457-2545
US

IV. Provider business mailing address

13324 SANFORD AVE APT. 9L
FLUSHING NY
11355-3650
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6389
  • Fax:
Mailing address:
  • Phone: 718-445-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005506
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: