Provider Demographics
NPI:1407945082
Name:YARBROUGH, J E (OD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:E
Last Name:YARBROUGH
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 1:1010 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2608
Mailing Address - Country:US
Mailing Address - Phone:864-984-6504
Mailing Address - Fax:
Practice Address - Street 1:1010 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2608
Practice Address - Country:US
Practice Address - Phone:864-984-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410001743OtherRAIL ROAD MEDICARE ID
SCD05297Medicaid
SC0172790001Medicare NSC
SC410001743OtherRAIL ROAD MEDICARE ID
SCD05297Medicaid