Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 008785 | NY |
Y | 152W00000X | Optometrist | 27OA00680100 | NJ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00680100 | NJ |
NPI | 1013400043 |
---|---|
Provider Name | Dr. Avi David Yehudai |
First Address | Chester, NJ 07930-2669 |
Second Address | Chester, NJ 07930-2669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 03/03/2021 |