Healthcare Provider Details

I. General information

NPI: 1700276656
Provider Name (Legal Business Name): YEALY EYE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N QUEEN ST 2ND FLOOR
LANCASTER PA
17603-3512
US

IV. Provider business mailing address

244 N QUEEN ST 2ND FLOOR
LANCASTER PA
17603-3512
US

V. Phone/Fax

Practice location:
  • Phone: 717-735-0746
  • Fax:
Mailing address:
  • Phone: 717-735-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: NATALIA GORDILLO YEALY
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 786-512-5469