Healthcare Provider Details

I. General information

NPI: 1194949321
Provider Name (Legal Business Name): SHERI YAMANISHI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19998 HOMESTEAD RD SUITE E
CUPERTINO CA
95014-0569
US

IV. Provider business mailing address

10806 LINDA VISTA DR
CUPERTINO CA
95014-4749
US

V. Phone/Fax

Practice location:
  • Phone: 408-257-5262
  • Fax: 408-257-8271
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10450T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: