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General NPI Number Information
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NPI Number | 1043259849
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Entity Type | Individual
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Provider Name | KEITH YAMANISHI O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 10535 HOSPITAL WAY BLDG 720
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City | MATHER
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State | CA
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Zip | 95655-4200
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Country | US
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Telephone | 916-366-5463
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Fax |
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Provider Business Mailing Address
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Address Line | 2169 NUGGET CREEK CT
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City | GOLD RIVER
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State | CA
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Zip | 95670-8127
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Country | US
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Telephone | 916-501-1032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT9381
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License Number State | CA
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