Provider Demographics
NPI:1255904520
Name:PACIFIC COAST OPTOMETRY, INC.
Entity type:Organization
Organization Name:PACIFIC COAST OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUKIO
Authorized Official - Middle Name:
Authorized Official - Last Name:UEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-916-5536
Mailing Address - Street 1:26761 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5769
Mailing Address - Country:US
Mailing Address - Phone:949-916-5536
Mailing Address - Fax:
Practice Address - Street 1:3030 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2562
Practice Address - Country:US
Practice Address - Phone:714-979-9687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255532826OtherNPI