Provider Demographics
NPI:1558374082
Name:YEAREGO, JOSEPH CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHRISTOPHER
Last Name:YEAREGO
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 1:220 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-4737
Mailing Address - Country:US
Mailing Address - Phone:304-842-4070
Mailing Address - Fax:
Practice Address - Street 1:220 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-4737
Practice Address - Country:US
Practice Address - Phone:304-842-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV902-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149515000Medicaid
YE0701383Medicare ID - Type Unspecified
U20971Medicare UPIN