Provider Demographics
NPI:1053742338
Name:JILL M YAMADA & MATTHEW M NISHIO, OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:JILL M YAMADA & MATTHEW M NISHIO, OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-393-5151
Mailing Address - Street 1:4433 FLORIN RD
Mailing Address - Street 2:SUITE 890
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2527
Mailing Address - Country:US
Mailing Address - Phone:916-393-5151
Mailing Address - Fax:916-392-6130
Practice Address - Street 1:4433 FLORIN RD
Practice Address - Street 2:SUITE 890
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2527
Practice Address - Country:US
Practice Address - Phone:916-393-5151
Practice Address - Fax:916-392-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11432T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty