Provider Demographics
NPI:1417927047
Name:YAMANE, JON H (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:H
Last Name:YAMANE
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 1:1545 NUTMEG PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2560
Mailing Address - Country:US
Mailing Address - Phone:714-847-1271
Mailing Address - Fax:714-362-9533
Practice Address - Street 1:18685 MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-847-1271
Practice Address - Fax:714-362-9533
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12380TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5582835Medicaid
CA5582835Medicaid
OP12380Medicare PIN
U97419Medicare UPIN