Provider Demographics
NPI:1558401810
Name:YASUDA, JERRY ARNETT (OD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ARNETT
Last Name:YASUDA
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 1:3300 S FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8109
Mailing Address - Country:US
Mailing Address - Phone:559-732-6687
Mailing Address - Fax:559-732-6633
Practice Address - Street 1:3300 SOUTH FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-732-6687
Practice Address - Fax:559-732-6633
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDOO83570Medicaid
CATO9525Medicare UPIN