Provider Demographics
NPI:1568528222
Name:K. LEO UYEDA, OD
Entity Type:Organization
Organization Name:K. LEO UYEDA, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATSUMASA
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:UYEDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-522-6703
Mailing Address - Street 1:5426 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1234
Mailing Address - Country:US
Mailing Address - Phone:714-522-6703
Mailing Address - Fax:714-522-6704
Practice Address - Street 1:5426 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1234
Practice Address - Country:US
Practice Address - Phone:714-522-6703
Practice Address - Fax:714-522-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7103T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0071031Medicaid
CA0004387552Medicare UPIN
CA210961Medicare UPIN
CA35127Medicare UPIN
CA48703Medicare UPIN
CASD0071031Medicaid
CA32166Medicare UPIN
CA22711Medicare UPIN
CAUY919645Medicare UPIN
CA=========Medicare UPIN
CAKU25282Medicare UPIN
CASD0071030Medicare UPIN
CAOP7103Medicare ID - Type UnspecifiedMEDICARE
CA46226Medicare UPIN