Provider Demographics
NPI:1770856791
Name:C. KENT YARBROUGH,O.D.,P.C.
Entity Type:Organization
Organization Name:C. KENT YARBROUGH,O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-503-7334
Mailing Address - Street 1:400 SHALLOWFORD RD NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-4152
Mailing Address - Country:US
Mailing Address - Phone:770-503-7334
Mailing Address - Fax:770-503-7321
Practice Address - Street 1:400 SHALLOWFORD RD NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-4152
Practice Address - Country:US
Practice Address - Phone:770-503-7334
Practice Address - Fax:770-503-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty