Provider Demographics
NPI:1457404147
Name:YAMASHIRO, MARIKO DAWN TAKEMOTO (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIKO
Middle Name:DAWN TAKEMOTO
Last Name:YAMASHIRO
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 1:937 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3111
Mailing Address - Country:US
Mailing Address - Phone:626-357-0408
Mailing Address - Fax:626-357-6768
Practice Address - Street 1:937 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3111
Practice Address - Country:US
Practice Address - Phone:626-357-0408
Practice Address - Fax:626-357-6768
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12863 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist