Provider Demographics
NPI:1558009225
Name:YOST, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:YOST
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 1:251 VINE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3326
Mailing Address - Country:US
Mailing Address - Phone:937-336-7850
Mailing Address - Fax:
Practice Address - Street 1:251 VINE ST
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3326
Practice Address - Country:US
Practice Address - Phone:937-336-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist