Basic Information
Provider Information
NPI: 1851607741
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YAECKEL
FirstName: CATHERINE
MiddleName: DAU
NamePrefix:  
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: DAU
OtherFirstName: CATHERINE
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3101 SW COLLEGE RD
Address2:  
City: OCALA
State: FL
PostalCode: 344748459
CountryCode: US
TelephoneNumber: 3522373768
FaxNumber: 3522374595
Practice Location
Address1: 3101 SW COLLEGE RD
Address2:  
City: OCALA
State: FL
PostalCode: 344748459
CountryCode: US
TelephoneNumber: 3522373768
FaxNumber: 3522374595
Other Information
ProviderEnumerationDate: 08/30/2010
LastUpdateDate: 05/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XOPC4515FLY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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