Healthcare Provider Details

I. General information

NPI: 1215695994
Provider Name (Legal Business Name): YEALY EYE EAST YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 E MARKET ST
YORK PA
17402-2848
US

IV. Provider business mailing address

244 N QUEEN ST
LANCASTER PA
17603-3512
US

V. Phone/Fax

Practice location:
  • Phone: 302-727-1384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A KERNISKY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 717-201-3238