Provider Demographics
NPI:1073566253
Name:MAYA, YARON H (OD)
Entity Type:Individual
Prefix:DR
First Name:YARON
Middle Name:H
Last Name:MAYA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:771 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4000
Practice Address - Country:US
Practice Address - Phone:954-584-3838
Practice Address - Fax:954-584-5011
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2900152W00000X
PAOEG003987152W00000X
VA0618003247152W00000X
FLOP0003250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8131BOtherMEDICARE ID
FL010834500Medicaid
FL010834500Medicaid
FLU71935Medicare UPIN
FL620370100Medicaid