Provider Demographics
NPI:1881661700
Name:YAMAMOTO, HARVEY H (OD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:H
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 1:417 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3427
Mailing Address - Country:US
Mailing Address - Phone:909-986-9951
Mailing Address - Fax:909-986-9812
Practice Address - Street 1:417 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3427
Practice Address - Country:US
Practice Address - Phone:909-986-9951
Practice Address - Fax:909-986-9812
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4477T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2480OtherDAVIS VISION PIN
CA6703OtherMEDICAL EYE SERVICES PIN
CA9V13089OtherINDIVIDUAL IEHP PIN
CASD0044770Medicaid
CASD0044770Medicare PIN
CA9V13089OtherINDIVIDUAL IEHP PIN