=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154643567
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMAN J. YELLOWHAIR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2010
-----------------------------------------------------
Last Update Date | 02/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | US HWY 160 & NAVAJO ROUTE 35 - RED MESA
-----------------------------------------------------
City | TEECNOSPOS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-656-5000
-----------------------------------------------------
Fax | 928-656-5164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HCR 6100 BOX 30
-----------------------------------------------------
City | TEECNOSPOS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-656-5000
-----------------------------------------------------
Fax | 928-656-5164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1201X
-----------------------------------------------------
Taxonomy Name | Optometric Assistant Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------