Provider Demographics
NPI:1588673677
Name:YODER, JOHN ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:YODER
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 1:7930 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:816-781-1389
Practice Address - Street 1:9220 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-1209
Practice Address - Country:US
Practice Address - Phone:816-781-1061
Practice Address - Fax:816-781-1389
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1778152W00000X
NE1132152W00000X
MO2005022668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317375905Medicaid
NE10025306800Medicaid
MO317375905Medicaid