Provider Demographics
NPI:1962464289
Name:YOAKUM, JAMES DANIEL III (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:YOAKUM
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:YOAKUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3211 ROGERS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-453-1220
Mailing Address - Fax:
Practice Address - Street 1:3211 ROGERS RD
Practice Address - Street 2:STE 100
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-453-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093KCMedicaid
NCU95353Medicare UPIN
NC89093KCMedicaid