Healthcare Provider Details

I. General information

NPI: 1770674590
Provider Name (Legal Business Name): LORI A YEAGLE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 MONTGOMERY ROAD #5
CINCINNATI OH
45236
US

IV. Provider business mailing address

7800 MONTGOMERY ROAD #5
CINCINNATI OH
45236
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-5970
  • Fax: 513-793-5976
Mailing address:
  • Phone: 513-793-5970
  • Fax: 513-793-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: