Provider Demographics
NPI:1306841762
Name:YANEY, JOHN STEVEN (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:YANEY
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 1:4300 ROGERS AVE
Mailing Address - Street 2:STE 46
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3152
Mailing Address - Country:US
Mailing Address - Phone:479-785-0010
Mailing Address - Fax:479-783-8478
Practice Address - Street 1:4300 ROGERS AVE
Practice Address - Street 2:STE 46
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3152
Practice Address - Country:US
Practice Address - Phone:479-785-0010
Practice Address - Fax:479-783-8478
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105893722Medicaid
AR49772Medicare PIN
T-20341Medicare UPIN
AR105893722Medicaid