MEDICARE: JOHN STEVEN YANEY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2324	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306841762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN STEVEN YANEY OD

Provider Business Mailing Address
First Line	:	4300 ROGERS AVE
Second Line	:	STE 46
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3152
Country	:	US
Telephone Number	:	479-785-0010
Fax Number	:	479-783-8478

Provider Business Practice Location Address
First Line	:	4300 ROGERS AVE
Second Line	:	STE 46
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3152
Country	:	US
Telephone Number	:	479-785-0010
Fax Number	:	479-783-8478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	05/12/2009

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