Provider Demographics
NPI:1801923487
Name:YEAGER, CYNTHIA W (OD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:W
Last Name:YEAGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:D
Other - Last Name:WIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3 BELLFORT CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6320
Mailing Address - Country:US
Mailing Address - Phone:864-246-0964
Mailing Address - Fax:
Practice Address - Street 1:2304 W PARKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-2123
Practice Address - Country:US
Practice Address - Phone:864-246-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist