MEDICARE: JOHN A. YODER, O.D., P.C.

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	2005022668	MO

General Provider Information

NPI Number	:	1558370627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A. YODER, O.D., P.C.

Provider Business Mailing Address
First Line	:	7930 N FOREST AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1524
Country	:	US
Telephone Number	:	816-651-6077
Fax Number	:	816-214-8662

Provider Business Practice Location Address
First Line	:	7930 N FOREST AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1524
Country	:	US
Telephone Number	:	816-651-6077
Fax Number	:	816-214-8662

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN ANDREW YODER
Credential	:	O.D.
Telephone Number	:	816-651-6077

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	08/29/2007

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