Provider Demographics
NPI:1144608415
Name:YODER, ANDREW D (OD)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:YODER
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1424 E FRONT ST
Practice Address - Street 2:DEHAVEN EYE CLINIC, PA
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8501
Practice Address - Country:US
Practice Address - Phone:903-595-4144
Practice Address - Fax:903-526-5491
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8712T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01547886OtherPALMETTO GBA
TXP02098791OtherMEDICARE RAIL ROAD
TX705193OtherMEDICARE
TX348374501Medicaid
TX348374502Medicaid