Provider Demographics
NPI:1053487116
Name:ONISHI, RYAN K (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:K
Last Name:ONISHI
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:31401 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1851
Mailing Address - Country:US
Mailing Address - Phone:949-496-0552
Mailing Address - Fax:949-443-3828
Practice Address - Street 1:31401 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1851
Practice Address - Country:US
Practice Address - Phone:949-496-0552
Practice Address - Fax:949-443-3828
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11380T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU81235Medicare UPIN