Healthcare Provider Details

I. General information

NPI: 1093804080
Provider Name (Legal Business Name): NATALIA GORDILLO YEALY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIA GORDILLO

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAINT CHARLES WAY
YORK PA
17402-4647
US

IV. Provider business mailing address

3687 WINGFIELD DR
YORK PA
17406-6670
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-2020
  • Fax:
Mailing address:
  • Phone: 786-512-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4281
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1826DT
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00004063
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2833
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002732
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: