Provider Demographics
NPI:1700820925
Name:YADON, J TRAVIS (OD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:TRAVIS
Last Name:YADON
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 1:10101 S PENN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6929
Mailing Address - Country:US
Mailing Address - Phone:405-691-3319
Mailing Address - Fax:405-691-1377
Practice Address - Street 1:10101 S PENN AVE
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6929
Practice Address - Country:US
Practice Address - Phone:405-691-3319
Practice Address - Fax:405-691-1377
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100760060AMedicaid
OK4585530001OtherPALMETTO
OK100760060AMedicaid