Individual
JACOB CARL YATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 CYPRESS BRANCH WAY STE 205, PALM COAST, FL 32164-8414
(386) 445-1880
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2416DT
KY
152W00000X
Optometrist
Primary
OPC6592
FL
Other
Enumeration date
07/22/2024
Last updated
12/19/2024
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