Provider Demographics
NPI:1174593156
Name:YAMADA, JILL MIDORI (OD,)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MIDORI
Last Name:YAMADA
Suffix:
Gender:F
Credentials:OD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 BELL RUSSELL WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4242
Mailing Address - Country:US
Mailing Address - Phone:916-393-5151
Mailing Address - Fax:
Practice Address - Street 1:4433 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2544
Practice Address - Country:US
Practice Address - Phone:916-393-5151
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10940T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU77129Medicare UPIN