Provider Demographics
NPI:1225451586
Name:LORI A. YEAGLE OD, LLC
Entity Type:Organization
Organization Name:LORI A. YEAGLE OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-257-6067
Mailing Address - Street 1:6339 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9148
Mailing Address - Country:US
Mailing Address - Phone:513-257-6067
Mailing Address - Fax:513-662-8786
Practice Address - Street 1:6000 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6318
Practice Address - Country:US
Practice Address - Phone:513-662-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty