Provider Demographics
NPI:1336483049
Name:JAMES A YANDELL
Entity Type:Organization
Organization Name:JAMES A YANDELL
Other - Org Name:NEWPORT EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:YANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-623-2020
Mailing Address - Street 1:303 COSBY HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2914
Mailing Address - Country:US
Mailing Address - Phone:423-623-2020
Mailing Address - Fax:423-623-3937
Practice Address - Street 1:303 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2914
Practice Address - Country:US
Practice Address - Phone:423-623-2020
Practice Address - Fax:423-623-3937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES A YANDELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507581Medicaid
TN3137807OtherBLUECROSS BLUESHIELD
TNP00332301OtherMEDICARE RAILROAD
TNP00332301OtherMEDICARE RAILROAD
TN3918780001Medicare NSC
TN35984401Medicare PIN