Provider Demographics
NPI:1174529721
Name:UMEDA, WESLEY S (OD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:S
Last Name:UMEDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4720
Mailing Address - Country:US
Mailing Address - Phone:916-965-1017
Mailing Address - Fax:
Practice Address - Street 1:7547 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4720
Practice Address - Country:US
Practice Address - Phone:916-965-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8039TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12945OtherMEDICAL EYE SERVICES
CA211134OtherEYEMED
CA410029077OtherRAILROAD MEDICARE
CA12945OtherMEDICAL EYE SERVICES
CAEF337ZMedicare PIN
CA410029077OtherRAILROAD MEDICARE