=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568642965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES E. YARBROUGH, OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 04/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 W MAIN ST
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-984-6504
-----------------------------------------------------
Fax | 864-984-6505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 W MAIN ST
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-984-6504
-----------------------------------------------------
Fax | 864-984-6505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES E YARBROUGH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 864-984-6504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------