MEDICARE: CYNTHIA W YEAGER 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	1026	SC

General Provider Information

NPI Number	:	1801923487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA W YEAGER OD

Provider Business Mailing Address
First Line	:	3 BELLFORT CT
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-6320
Country	:	US
Telephone Number	:	864-246-0964
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 W PARKER RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-2123
Country	:	US
Telephone Number	:	864-246-0964
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	12/27/2012

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