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General NPI Number Information
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NPI Number | 1962442848
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Entity Type | Individual
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Provider Name | BURNESS R YANDELL OD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 1013 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-2847
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Country | US
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Telephone | 918-786-9777
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Fax | 918-786-3345
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Provider Business Mailing Address
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Address Line | P.O. BOX 452529
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City | GROVE
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State | OK
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Zip | 74345-2529
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Country | US
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Telephone | 918-786-9777
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Fax | 918-786-3345
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 970
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License Number State | OK
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