Healthcare Provider Details

I. General information

NPI: 1043294929
Provider Name (Legal Business Name): RONALD YONEO HAYASHIDA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56970 YUCCA TRL
YUCCA VALLEY CA
92284-3753
US

IV. Provider business mailing address

56970 YUCCA TRL
YUCCA VALLEY CA
92284-3753
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-2020
  • Fax: 760-369-2020
Mailing address:
  • Phone: 760-228-2020
  • Fax: 760-369-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT4574T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: