Provider Demographics
NPI:1912992835
Name:YUMORI, RANDALL WATARU (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WATARU
Last Name:YUMORI
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 1:12461 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5511
Mailing Address - Country:US
Mailing Address - Phone:310-390-6287
Mailing Address - Fax:310-391-8464
Practice Address - Street 1:12461 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5511
Practice Address - Country:US
Practice Address - Phone:310-390-6287
Practice Address - Fax:310-391-8464
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07100T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWY5748Medicare PIN
CAU30197Medicare UPIN