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Individual

MR. ANDREW D. YODER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1424 E FRONT ST, DEHAVEN EYE CLINIC, PA, TYLER, TX 75702-8501
(903) 595-4144
(903) 526-5491
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8712T
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
348374501
TX
05
348374502
TX
01
705193
MEDICARE
TX
01
P01547886
PALMETTO GBA
TX
01
P02098791
MEDICARE RAIL ROAD
TX
Enumeration date
05/07/2015
Last updated
11/06/2018
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