Healthcare Provider Details

I. General information

NPI: 1649947391
Provider Name (Legal Business Name): ERIC DREW YOSHINAGA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2021
Last Update Date: 12/02/2022
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 WILSHIRE BLVD STE 203
SANTA MONICA CA
90403-5790
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-0160
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12449720-9934
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT34970
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPFC103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: