Provider Demographics
NPI:1417521287
Name:DAVE, YASH
Entity Type:Individual
Prefix:
First Name:YASH
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 CROSSCUT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9564
Mailing Address - Country:US
Mailing Address - Phone:757-981-6616
Mailing Address - Fax:
Practice Address - Street 1:115 COLISEUM XING STE 58
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5971
Practice Address - Country:US
Practice Address - Phone:757-751-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist