Provider Demographics
NPI:1558414078
Name:YOSHIMURA, LINDA (OD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:YOSHIMURA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 VIA DEL AGUILA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3569
Mailing Address - Country:US
Mailing Address - Phone:714-777-1434
Mailing Address - Fax:
Practice Address - Street 1:843 NEWPORT CENTER DR
Practice Address - Street 2:NEWPORT FASHION ISLAND #84
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6943
Practice Address - Country:US
Practice Address - Phone:949-718-2040
Practice Address - Fax:949-718-2044
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8617T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13911Medicare UPIN