MEDICARE: YEAGER OCULAR PROSTHETICS, LLC

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	156FX1700X	Ocularist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17-387	OTHER		NEBO

General Provider Information

NPI Number	:	1386220648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YEAGER OCULAR PROSTHETICS, LLC

Provider Business Mailing Address
First Line	:	2050 KEOKUK ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4551
Country	:	US
Telephone Number	:	319-337-9724
Fax Number	:	319-337-5445

Provider Business Practice Location Address
First Line	:	2050 KEOKUK ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4551
Country	:	US
Telephone Number	:	319-337-9724
Fax Number	:	319-337-5445

Authorized Official
Title or Position	:	OWNER
Name	:	HILLARY YEAGER
Credential	:	BCO, BADO
Telephone Number	:	319-337-9724

Provider Enumeration Date	:	03/18/2021
Last Update Date	:	11/01/2021

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