Provider Demographics
NPI:1568659340
Name:YAMAMOTO, SHAWN TAKASHI (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:TAKASHI
Last Name:YAMAMOTO
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 1:2551 PEARBLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4407
Mailing Address - Country:US
Mailing Address - Phone:714-869-3239
Mailing Address - Fax:
Practice Address - Street 1:4275 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2801
Practice Address - Country:US
Practice Address - Phone:562-595-5662
Practice Address - Fax:562-988-2082
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist