Provider Demographics
NPI:1255309480
Name:UYEDA, JOSEPH T (O D)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:UYEDA
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 MULFORD ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4349 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3755
Practice Address - Country:US
Practice Address - Phone:847-677-8022
Practice Address - Fax:847-677-8029
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208705Medicare ID - Type Unspecified
ILU12360Medicare UPIN