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NPI Code Detail

MEDICARE: DR. TERRY LEE YARBROUGH O.D.

MEDICARE: DR. TERRY LEE YARBROUGH O.D.
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
1152W00000XOptometristOPT001902GA

General Provider Information

NPI Number : 1639395379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY LEE YARBROUGH O.D.
Provider Business Mailing Address
First Line : 3485 ROLLING CREEK DR
Second Line :
City : BUFORD
State : GA
Zip : 30519-4516
Country : US
Telephone Number : 678-546-4834
Fax Number :
Provider Business Practice Location Address
First Line : 400 SHALLOWFORD RD NW
Second Line :
City : GAINESVILLE
State : GA
Zip : 30504-4152
Country : US
Telephone Number : 770-503-7334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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