Provider Demographics
NPI:1770674590
Name:YEAGLE, LORI A (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:YEAGLE
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 1:7800 MONTGOMERY ROAD
Mailing Address - Street 2:#5
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236
Mailing Address - Country:US
Mailing Address - Phone:513-793-5970
Mailing Address - Fax:513-793-5976
Practice Address - Street 1:7800 MONTGOMERY ROAD
Practice Address - Street 2:#5
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236
Practice Address - Country:US
Practice Address - Phone:513-793-5970
Practice Address - Fax:513-793-5976
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4856152WC0802X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU99610Medicare UPIN