Provider Demographics
NPI:1073185112
Name:DR JEFFREY J YOCUM
Entity Type:Organization
Organization Name:DR JEFFREY J YOCUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-742-2930
Mailing Address - Street 1:637 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1143
Mailing Address - Country:US
Mailing Address - Phone:765-742-2930
Mailing Address - Fax:
Practice Address - Street 1:637 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1143
Practice Address - Country:US
Practice Address - Phone:765-742-2930
Practice Address - Fax:765-429-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty