Provider Demographics
NPI:1083806970
Name:DAVID P YESNICK OD PROF CORP
Entity Type:Organization
Organization Name:DAVID P YESNICK OD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-966-2020
Mailing Address - Street 1:9191 W FLAMINGO RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6859
Mailing Address - Country:US
Mailing Address - Phone:702-966-2020
Mailing Address - Fax:702-966-2022
Practice Address - Street 1:9191 W FLAMINGO RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6859
Practice Address - Country:US
Practice Address - Phone:702-966-2020
Practice Address - Fax:702-966-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6284090001Medicare NSC
NVU73581Medicare UPIN
NVV40270Medicare PIN