Provider Demographics
NPI:1376683409
Name:OSAKO, EUGENE YOICHI (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:YOICHI
Last Name:OSAKO
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 1:10724 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3314
Mailing Address - Country:US
Mailing Address - Phone:310-559-0500
Mailing Address - Fax:310-559-4009
Practice Address - Street 1:10724 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3314
Practice Address - Country:US
Practice Address - Phone:310-559-0500
Practice Address - Fax:310-559-4009
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11723TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117230Medicaid
CAWOP11723Medicare PIN