Provider Demographics
NPI:1194037366
Name:YARNELL, SHAWN M (OD,)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:YARNELL
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:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-0080
Mailing Address - Country:US
Mailing Address - Phone:417-345-2901
Mailing Address - Fax:417-345-2904
Practice Address - Street 1:112 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-7614
Practice Address - Country:US
Practice Address - Phone:417-345-2901
Practice Address - Fax:417-345-2904
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist