Provider Demographics
NPI:1508916289
Name:IOSUE, RICHARD ALAN (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:IOSUE
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 1:1233 W RANCHO VISTA BLVD
Mailing Address - Street 2:C O EYEXAM OF CA. STE 737
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3947
Mailing Address - Country:US
Mailing Address - Phone:661-575-9099
Mailing Address - Fax:661-575-9091
Practice Address - Street 1:1233 W RANCHO VISTA BLVD
Practice Address - Street 2:C O EYEXAM OF CA. STE 737
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3947
Practice Address - Country:US
Practice Address - Phone:661-575-9099
Practice Address - Fax:661-575-9091
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7880T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU43288Medicare UPIN
CAWOP7880Medicare ID - Type Unspecified