Provider Demographics
NPI:1194801761
Name:UYEDA, K. LEO (OD)
Entity type:Individual
Prefix:DR
First Name:K.
Middle Name:LEO
Last Name:UYEDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:KATSUMASA
Other - Middle Name:LEO
Other - Last Name:UYEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:14820 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4251
Mailing Address - Country:US
Mailing Address - Phone:714-522-6703
Mailing Address - Fax:714-522-7623
Practice Address - Street 1:14820 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4251
Practice Address - Country:US
Practice Address - Phone:714-522-6703
Practice Address - Fax:714-522-7623
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7103T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0071031Medicaid
CA210961Medicare UPIN
CASD0071030Medicare UPIN
CA46226Medicare UPIN
CA48703Medicare UPIN
CA953667555Medicare UPIN
CA5874690001Medicare NSC
CAUY919645Medicare UPIN
CA0004387552Medicare UPIN
CA03689Medicare UPIN
CA35127Medicare UPIN
CAKU25282Medicare UPIN
CASD0071031Medicaid