Provider Demographics
NPI:1619545357
Name:YOVICH, LAUREN KAYE (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KAYE
Last Name:YOVICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-4604
Mailing Address - Country:US
Mailing Address - Phone:419-782-3937
Mailing Address - Fax:419-782-3930
Practice Address - Street 1:283 STADIUM DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-4604
Practice Address - Country:US
Practice Address - Phone:419-782-3937
Practice Address - Fax:419-782-3930
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist