Provider Demographics
NPI:1619238540
Name:YEARLING, ASHLEY NICOLE (OD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:YEARLING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:HIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1817 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-8958
Mailing Address - Country:US
Mailing Address - Phone:765-210-7614
Mailing Address - Fax:
Practice Address - Street 1:506 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-1961
Practice Address - Country:US
Practice Address - Phone:765-662-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003729A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201198550Medicaid