Healthcare Provider Details

I. General information

NPI: 1225875487
Provider Name (Legal Business Name): RHYS JENKINS YARNS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIFFLIN AVE
SCRANTON PA
18503-1982
US

IV. Provider business mailing address

2009 CARDINAL LN
SOUTH ABINGTON TOWNSHIP PA
18411-9292
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3145
  • Fax:
Mailing address:
  • Phone: 570-507-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004154
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: