Provider Demographics
NPI:1508027269
Name:YARYAN, KEVIN ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:YARYAN
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:P O BOX 427
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331
Mailing Address - Country:US
Mailing Address - Phone:765-825-4127
Mailing Address - Fax:765-827-6577
Practice Address - Street 1:522 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331
Practice Address - Country:US
Practice Address - Phone:765-825-4127
Practice Address - Fax:765-827-6577
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003524A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN260070OtherMEDICARE PTAN
IN6199440001Medicare NSC