Provider Demographics
NPI:1700276656
Name:YEALY EYE, LLC
Entity Type:Organization
Organization Name:YEALY EYE, LLC
Other - Org Name:YEALY EYE CARE AND DRY EYE CENTER OF LANCASTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:GORDILLO
Authorized Official - Last Name:YEALY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-512-5469
Mailing Address - Street 1:244 N QUEEN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3512
Mailing Address - Country:US
Mailing Address - Phone:717-735-0746
Mailing Address - Fax:
Practice Address - Street 1:244 N QUEEN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3512
Practice Address - Country:US
Practice Address - Phone:717-735-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029995600001Medicaid