Healthcare Provider Details

I. General information

NPI: 1558374082
Provider Name (Legal Business Name): JOSEPH CHRISTOPHER YEAREGO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SOUTHVIEW DR
BRIDGEPORT WV
26330-4737
US

IV. Provider business mailing address

220 SOUTHVIEW DR
BRIDGEPORT WV
26330-4737
US

V. Phone/Fax

Practice location:
  • Phone: 304-842-4070
  • Fax:
Mailing address:
  • Phone: 304-842-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number902-OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: