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General NPI Number Information
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NPI Number | 1053638403
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Entity Type | Organization
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Legal Business Name | K ANDREW YARYAN OD LLC
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 09/03/2012
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Provider Practice Location Address
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Address Line | 522 N EASTERN AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-1935
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Country | US
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Telephone | 765-825-4127
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Fax | 765-827-6577
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Provider Business Mailing Address
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Address Line | 522 N EASTERN AVE PO BOX 427
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City | CONNERSVILLE
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State | IN
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Zip | 47331-1935
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Country | US
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Telephone | 765-825-4127
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Fax | 765-827-6577
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. KEVIN ANDREW YARYAN
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Credential | O.D.
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Telephone | 765-825-4127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003524A
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License Number State | IN
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