Individual
BURNESS R YANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1013 S MAIN ST, GROVE, OK 74344-2847
(918) 786-9777
(918) 786-3345
Mailing address
P.O. BOX 452529, GROVE, OK 74345-2529
(918) 786-9777
(918) 786-3345
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
970
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110763110A
—
OK
01
—
1962442848
ADVANTRA FREEDOM
OK
01
—
731086218001
BCBS
—
Enumeration date
06/07/2006
Last updated
08/05/2009
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