Provider Demographics
NPI:1124283577
Name:J STEVEN YANEY
Entity type:Organization
Organization Name:J STEVEN YANEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:YANEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-785-0010
Mailing Address - Street 1:4300 ROGERS AVE
Mailing Address - Street 2:GREENPOINTE CENTER SUITE 46
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3152
Mailing Address - Country:US
Mailing Address - Phone:479-785-0010
Mailing Address - Fax:479-782-8478
Practice Address - Street 1:4300 ROGERS AVE
Practice Address - Street 2:GREENPOINTE CENTER SUITE 46
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3152
Practice Address - Country:US
Practice Address - Phone:479-785-0010
Practice Address - Fax:479-782-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105893722Medicaid
OK200034470AMedicaid
OK200034470AMedicaid