MEDICARE: DR. SHAWN TAKASHI YAMAMOTO 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	13421	CA

General Provider Information

NPI Number	:	1568659340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN TAKASHI YAMAMOTO O.D.

Provider Business Mailing Address
First Line	:	2551 PEARBLOSSOM ST
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-4407
Country	:	US
Telephone Number	:	714-869-3239
Fax Number	:

Provider Business Practice Location Address
First Line	:	4275 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2801
Country	:	US
Telephone Number	:	562-595-5662
Fax Number	:	562-988-2082

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	11/30/2016

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