Provider Demographics
NPI:1114041449
Name:UYENO, GARY ISAMU (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ISAMU
Last Name:UYENO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5316
Mailing Address - Country:US
Mailing Address - Phone:562-438-1211
Mailing Address - Fax:562-438-0821
Practice Address - Street 1:5219 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5316
Practice Address - Country:US
Practice Address - Phone:562-438-1211
Practice Address - Fax:562-438-0821
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7078T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82722Medicare UPIN