Provider Demographics
NPI:1497249429
Name:YEAGER, ANDREW R
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:YEAGER
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 1:31995 HIGHWAY U
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-0831
Mailing Address - Country:US
Mailing Address - Phone:660-287-2849
Mailing Address - Fax:
Practice Address - Street 1:31995 HIGHWAY U
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-0831
Practice Address - Country:US
Practice Address - Phone:660-287-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018021281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist