Provider Demographics
NPI:1659798742
Name:UY, MARIA (OD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:UY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:UY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:12503 N MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8889
Mailing Address - Country:US
Mailing Address - Phone:909-899-1267
Mailing Address - Fax:909-899-7518
Practice Address - Street 1:12503 N MAINSTREET
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8889
Practice Address - Country:US
Practice Address - Phone:909-899-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12666944OtherCAQH PROVIDER ID