Provider Demographics
NPI:1568482271
Name:YOAKUM, JOHN SPENCER (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SPENCER
Last Name:YOAKUM
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:PO BOX 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1300 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2349
Practice Address - Country:US
Practice Address - Phone:336-884-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1635152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22819OtherOPTICARE
NC890900AMedicaid
NC18768OtherPARTNERS
NC2208350OtherUNITED HEALTHCARE OF NC
NC5609966OtherCIGNA
NC0900AOtherBLUE CROSS BLUE SHIELD
NC0900AOtherBLUE CROSS BLUE SHIELD
NC2208350OtherUNITED HEALTHCARE OF NC