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NPI Code Detail

MEDICARE: C. KENT YARBROUGH,O.D.,P.C.

MEDICARE: C. KENT YARBROUGH,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
1152W00000XOptometristOPT001369GA

General Provider Information

NPI Number : 1770856791
Entity Type Code : Organization
Provider Name (Legal Business Name) : C. KENT YARBROUGH,O.D.,P.C.
Provider Business Mailing 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 : 770-503-7321
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 : 770-503-7321
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. CHARLES KENT YARBROUGH
Credential : O.D.
Telephone Number : 770-503-7334
Provider Enumeration Date : 02/22/2012
Last Update Date : 02/22/2012

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