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Individual

KENNETH ANTHONY YEAGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2304 W PARKER RD, GREENVILLE, SC 29617-2123
(864) 246-0964
Mailing address
2304W PARKER RD, GREENVILLE, SC 29617-2123
(864) 246-0964

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1027
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
D10272
SC
Enumeration date
05/11/2006
Last updated
10/15/2020
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