Provider Demographics
NPI:1699789560
Name:YANES, TERESITA (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:TERESITA
Middle Name:
Last Name:YANES
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10141 E BROADVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1122
Mailing Address - Country:US
Mailing Address - Phone:305-865-2772
Mailing Address - Fax:305-445-3625
Practice Address - Street 1:3025 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3207
Practice Address - Country:US
Practice Address - Phone:305-446-3025
Practice Address - Fax:305-445-3625
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL492156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician