Provider Demographics
NPI:1750498457
Name:TAYLOR-ROSE, YOLANDA (OD)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:
Last Name:TAYLOR-ROSE
Suffix:
Gender:F
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:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0650
Mailing Address - Country:US
Mailing Address - Phone:334-872-2321
Mailing Address - Fax:334-872-2391
Practice Address - Street 1:2401 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-7756
Practice Address - Country:US
Practice Address - Phone:334-872-2321
Practice Address - Fax:334-872-2391
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A03-TA-575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51504510OtherBLUE AND CROSS SHEILD NUM
AL0000046510Medicaid
ALS-A03TA575OtherLICENSE NUMBER
ALU87797Medicare UPIN