Provider Demographics
NPI:1215027917
Name:YATSKEVICH, ARKADY (OD)
Entity Type:Individual
Prefix:
First Name:ARKADY
Middle Name:
Last Name:YATSKEVICH
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 1:820 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2727
Mailing Address - Country:US
Mailing Address - Phone:302-678-3545
Mailing Address - Fax:302-734-3115
Practice Address - Street 1:820 WALKER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2727
Practice Address - Country:US
Practice Address - Phone:302-678-3545
Practice Address - Fax:302-734-3115
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE13-00001304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00564Medicare PIN