Provider Demographics
NPI:1578551404
Name:YI POWELL, GLARA N (OD)
Entity Type:Individual
Prefix:
First Name:GLARA
Middle Name:N
Last Name:YI POWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GLARA
Other - Middle Name:NK
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6091 S POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4899
Mailing Address - Country:US
Mailing Address - Phone:239-985-7171
Mailing Address - Fax:239-985-7118
Practice Address - Street 1:6091 S POINTE BLVD
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4899
Practice Address - Country:US
Practice Address - Phone:239-985-7171
Practice Address - Fax:239-985-7118
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45034OtherBCBS
FL45034OtherBCBS
45034Medicare PIN