Provider Demographics
NPI:1912992439
Name:YOCUM, JEFFREY JON (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JON
Last Name:YOCUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1143
Mailing Address - Country:US
Mailing Address - Phone:765-742-2930
Mailing Address - Fax:765-429-6160
Practice Address - Street 1:637 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1143
Practice Address - Country:US
Practice Address - Phone:765-742-2930
Practice Address - Fax:765-429-6160
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1800-2445B152W00000X
IN1800-2445AB332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100232920AMedicaid
IN808270Medicare ID - Type Unspecified
IN100232920AMedicaid
INT59269Medicare UPIN