Provider Demographics
NPI:1285488528
Name:IRINA YAKUBIN OD OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:IRINA YAKUBIN OD OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-961-1631
Mailing Address - Street 1:718 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1404
Mailing Address - Country:US
Mailing Address - Phone:323-961-1631
Mailing Address - Fax:
Practice Address - Street 1:718 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1404
Practice Address - Country:US
Practice Address - Phone:323-961-1631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist