MEDICARE: BURNESS R YANDELL 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	970	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962442848	OTHER	OK	ADVANTRA FREEDOM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	731086218001	OTHER		BCBS

General Provider Information

NPI Number	:	1962442848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BURNESS R YANDELL OD

Provider Business Mailing Address
First Line	:	P.O. BOX 452529
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74345-2529
Country	:	US
Telephone Number	:	918-786-9777
Fax Number	:	918-786-3345

Provider Business Practice Location Address
First Line	:	1013 S MAIN ST
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-2847
Country	:	US
Telephone Number	:	918-786-9777
Fax Number	:	918-786-3345

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/05/2009

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Directions to “ BURNESS R YANDELL OD” Practice Location

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