MEDICARE: DR. RANDALL WATARU YUMORI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	07100T	CA

General Provider Information

NPI Number	:	1912992835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL WATARU YUMORI O.D.

Provider Business Mailing Address
First Line	:	12461 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5511
Country	:	US
Telephone Number	:	310-390-6287
Fax Number	:	310-391-8464

Provider Business Practice Location Address
First Line	:	12461 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5511
Country	:	US
Telephone Number	:	310-390-6287
Fax Number	:	310-391-8464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	06/11/2013

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