Provider Demographics
NPI:1588808307
Name:REX A. YANNIS, MD, A PROF. CORP.
Entity type:Organization
Organization Name:REX A. YANNIS, MD, A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:YANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-481-5511
Mailing Address - Street 1:146 TRAFFIC WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3376
Mailing Address - Country:US
Mailing Address - Phone:805-481-5511
Mailing Address - Fax:805-481-9631
Practice Address - Street 1:146 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3376
Practice Address - Country:US
Practice Address - Phone:805-481-5511
Practice Address - Fax:805-481-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42705207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty