Healthcare Provider Details

I. General information

NPI: 1912603366
Provider Name (Legal Business Name): YACKELS EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4798 S MOORLAND RD
NEW BERLIN WI
53151-7486
US

IV. Provider business mailing address

1221 COBBLESTONE PL
WEST BEND WI
53095-4585
US

V. Phone/Fax

Practice location:
  • Phone: 262-207-0023
  • Fax: 262-465-0708
Mailing address:
  • Phone: 262-207-0023
  • Fax: 262-465-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TODD MATTHEW YACKELS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 262-207-0023