Provider Demographics
NPI:1447227384
Name:HARVEY H YAMAMOTO, OD, INC.
Entity Type:Organization
Organization Name:HARVEY H YAMAMOTO, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-986-9951
Mailing Address - Street 1:417 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3427
Mailing Address - Country:US
Mailing Address - Phone:909-986-9951
Mailing Address - Fax:909-986-9812
Practice Address - Street 1:417 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3427
Practice Address - Country:US
Practice Address - Phone:909-986-9951
Practice Address - Fax:909-986-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4477T152W00000X
CA10183T152W00000X
CA11326T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9V21089OtherGROUP IEHP PIN
CAGSD000750Medicaid
CAGSD000750Medicaid
CAZZZ15696ZMedicare PIN