Provider Demographics
NPI:1255377040
Name:YESNICK, DAVID P (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:YESNICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9191 W FLAMINGO RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6859
Mailing Address - Country:US
Mailing Address - Phone:702-966-2020
Mailing Address - Fax:702-966-2022
Practice Address - Street 1:9191 W FLAMINGO RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6859
Practice Address - Country:US
Practice Address - Phone:702-966-2020
Practice Address - Fax:702-966-2022
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV335152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002502048Medicaid
NVV40272Medicare PIN
NVU73581Medicare UPIN