Provider Demographics
NPI:1811181787
Name:CHRISTOPHER YEAREGO, OD AND ASSOCIATES, PLLC
Entity type:Organization
Organization Name:CHRISTOPHER YEAREGO, OD AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:YEAREGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-637-5554
Mailing Address - Street 1:721 BEVERLY PIKE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9729
Mailing Address - Country:US
Mailing Address - Phone:304-637-5554
Mailing Address - Fax:304-637-2666
Practice Address - Street 1:721 BEVERLY PIKE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9729
Practice Address - Country:US
Practice Address - Phone:304-637-5554
Practice Address - Fax:304-637-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV902 OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149515000Medicaid
U20971Medicare UPIN
WV0149515000Medicaid