Provider Demographics
NPI:1053894295
Name:YANA REPKIN, O.D., A PROF. CORP.
Entity type:Organization
Organization Name:YANA REPKIN, O.D., A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-997-1179
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-1089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:858-486-1963
Practice Address - Street 1:13425 COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4723
Practice Address - Country:US
Practice Address - Phone:858-486-1954
Practice Address - Fax:858-486-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty