Provider Demographics
NPI:1558370627
Name:JOHN A. YODER, O.D., P.C.
Entity Type:Organization
Organization Name:JOHN A. YODER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-651-6077
Mailing Address - Street 1:7930 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1524
Mailing Address - Country:US
Mailing Address - Phone:816-651-6077
Mailing Address - Fax:816-214-8662
Practice Address - Street 1:7930 N FOREST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1524
Practice Address - Country:US
Practice Address - Phone:816-651-6077
Practice Address - Fax:816-214-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT500000Medicare ID - Type Unspecified