Provider Demographics
NPI:1295772853
Name:UESHIRO, LYNN H (OD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:H
Last Name:UESHIRO
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 1:1257 NE PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-4094
Mailing Address - Country:US
Mailing Address - Phone:503-970-0719
Mailing Address - Fax:
Practice Address - Street 1:2043 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1756
Practice Address - Country:US
Practice Address - Phone:503-352-3133
Practice Address - Fax:503-352-2261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2819ATI152W00000X
NV333152W00000X
HI458152W00000X
TX5365T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230629Medicaid
ORU68521Medicare UPIN
OR112177Medicare ID - Type Unspecified