MEDICARE: NOAH MICHAEL YUCHNITZ

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1952655599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH MICHAEL YUCHNITZ

Provider Business Mailing Address
First Line	:	5545 NW LOOP 410
Second Line	:	STE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1825
Country	:	US
Telephone Number	:	210-859-9826
Fax Number	:

Provider Business Practice Location Address
First Line	:	5545 NW LOOP 410
Second Line	:	103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1825
Country	:	US
Telephone Number	:	210-859-9826
Fax Number	:

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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