Provider Demographics
NPI:1700995933
Name:YAGER, JACK J (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:J
Last Name:YAGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 DE PHILLIPS BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-351-3231
Mailing Address - Fax:407-354-3397
Practice Address - Street 1:7051 DE PHILLIPS BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-351-3231
Practice Address - Fax:407-354-3397
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1134152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19928ZMedicare PIN
FL19928ZMedicare ID - Type Unspecified
FLT84034Medicare UPIN
FL0455110001Medicare NSC
FL00882Medicare PIN
FL410009992Medicare PIN