Provider Demographics
NPI:1093739971
Name:YATES, CALVIN BUTLER (OD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:BUTLER
Last Name:YATES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3013
Mailing Address - Country:US
Mailing Address - Phone:219-981-8890
Mailing Address - Fax:
Practice Address - Street 1:141 E 61ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3013
Practice Address - Country:US
Practice Address - Phone:219-981-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001647A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN445640Medicare PIN