Provider Demographics
NPI:1396123469
Name:KRESCH, YOCHEVED
Entity type:Individual
Prefix:
First Name:YOCHEVED
Middle Name:
Last Name:KRESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25211 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3165
Mailing Address - Country:US
Mailing Address - Phone:248-545-2800
Mailing Address - Fax:248-581-4074
Practice Address - Street 1:25211 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3165
Practice Address - Country:US
Practice Address - Phone:248-545-2800
Practice Address - Fax:248-581-4074
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005359152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics