Healthcare Provider Details

I. General information

NPI: 1134122260
Provider Name (Legal Business Name): ROBERT BRIAN YEAMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E US HIGHWAY 377
GRANBURY TX
76049-7432
US

IV. Provider business mailing address

4000 E US HIGHWAY 377
GRANBURY TX
76049-7432
US

V. Phone/Fax

Practice location:
  • Phone: 817-573-7153
  • Fax: 817-573-5640
Mailing address:
  • Phone: 817-573-7153
  • Fax: 817-573-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4171TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: