Provider Demographics
NPI:1609905603
Name:YANCHO, JOHN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:YANCHO
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 1:12773 W RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9554
Mailing Address - Country:US
Mailing Address - Phone:989-695-6869
Mailing Address - Fax:989-791-1918
Practice Address - Street 1:4900 FASHION SQUARE MALL
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2706
Practice Address - Country:US
Practice Address - Phone:989-799-1184
Practice Address - Fax:989-791-1918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI912345OtherEYEMED
MIMI2427Medicare PIN