Provider Demographics
NPI:1790310811
Name:YAVAPAI OPTICAL LLC
Entity Type:Organization
Organization Name:YAVAPAI OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-775-9393
Mailing Address - Street 1:7763 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2289
Mailing Address - Country:US
Mailing Address - Phone:928-775-9393
Mailing Address - Fax:928-772-1279
Practice Address - Street 1:7763 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2289
Practice Address - Country:US
Practice Address - Phone:928-775-9393
Practice Address - Fax:928-772-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty