Individual ProviderDominic Walter YsidronStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1 Ohio University Dept Of Psychology, Porter Hall Room 002, Athens, OH 45701(740) 593-0902PECOS EnrollmentBased on the most recent information from CMS, provider Dominic Walter Ysidron does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1851852891Provider TypeIndividualFull NameYsidron, Dominic WalterGenderMaleSole ProprietorNoEnumeration Date3/30/2019Last Updated3/30/2019Contact InformationPractice LocationPractice Address1 Ohio University Dept Of Psychology, Porter Hall Room 002, Athens, OH 45701Phone(740) 593-0902FaxUnlisted FaxMailing LocationMailing Address1 Ohio University Dept Of Psychology, Porter Hall Room 002, Athens, OH 45701Phone(740) 593-0902FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer