Provider Demographics
NPI:1447303151
Name:YARWOOD, PAGE ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:PAGE
Middle Name:ALLEN
Last Name:YARWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:609 KENWYN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3714
Mailing Address - Country:US
Mailing Address - Phone:510-763-7736
Mailing Address - Fax:510-752-7742
Practice Address - Street 1:3772 HOWE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5311
Practice Address - Country:US
Practice Address - Phone:510-752-6633
Practice Address - Fax:510-752-7742
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06144T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist