Provider Demographics
NPI:1841579570
Name:BARGENDER, YANA YURIVNA (OD)
Entity Type:Individual
Prefix:DR
First Name:YANA
Middle Name:YURIVNA
Last Name:BARGENDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:YURIVNA
Other - Last Name:YEGIAZAROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:776 WATER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-1272
Mailing Address - Country:US
Mailing Address - Phone:315-663-6929
Mailing Address - Fax:
Practice Address - Street 1:300 LYCOMING MALL CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8072
Practice Address - Country:US
Practice Address - Phone:570-546-3115
Practice Address - Fax:570-546-6498
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002536152W00000X
NYTUV007785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist