MEDICARE: DR. GIRMA G YEMANE 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	1089	NV

General Provider Information

NPI Number	:	1548857675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIRMA G YEMANE OD

Provider Business Mailing Address
First Line	:	4955 LINDELL RD APT 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1371
Country	:	US
Telephone Number	:	702-290-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	3614 S MARYLAND PKWY # 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3033
Country	:	US
Telephone Number	:	702-341-7254
Fax Number	:	702-255-5795

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

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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