Provider Demographics
NPI:1164872230
Name:YAKOVLEVA, NATALIYA A (OD)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:A
Last Name:YAKOVLEVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 GATE PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7277
Mailing Address - Country:US
Mailing Address - Phone:904-503-4108
Mailing Address - Fax:904-035-7153
Practice Address - Street 1:7840 GATE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7277
Practice Address - Country:US
Practice Address - Phone:904-503-4801
Practice Address - Fax:904-503-7153
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist