Provider Demographics
NPI:1932142841
Name:SHIROYAMA, ONA MAE REIKO (OD)
Entity Type:Individual
Prefix:DR
First Name:ONA MAE
Middle Name:REIKO
Last Name:SHIROYAMA
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 1:1280 S VICTORIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6555
Mailing Address - Country:US
Mailing Address - Phone:805-650-9922
Mailing Address - Fax:805-650-6656
Practice Address - Street 1:1280 S VICTORIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6555
Practice Address - Country:US
Practice Address - Phone:805-650-9922
Practice Address - Fax:805-650-6656
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6802T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0068020Medicaid
CASD0068020Medicaid
CAT70142Medicare UPIN