Provider Demographics
NPI:1114776549
Name:YAMAMOTO, LEON EDWARD (OD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:EDWARD
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR STE 207
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0323
Mailing Address - Country:US
Mailing Address - Phone:949-552-2020
Mailing Address - Fax:949-552-6777
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:STE 207
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0323
Practice Address - Country:US
Practice Address - Phone:949-552-2020
Practice Address - Fax:949-552-6777
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist