Provider Demographics
NPI:1952436586
Name:YASUDA, MASARU (OD)
Entity type:Individual
Prefix:DR
First Name:MASARU
Middle Name:
Last Name:YASUDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MAS
Other - Middle Name:
Other - Last Name:YASUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:16413 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2092
Mailing Address - Country:US
Mailing Address - Phone:562-926-4832
Mailing Address - Fax:562-402-8410
Practice Address - Street 1:10929 SOUTH ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5340
Practice Address - Country:US
Practice Address - Phone:562-402-1525
Practice Address - Fax:562-402-8410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4144T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0041440Medicaid