Individual provider Active NPI

Mariko Dawn Takemoto Yamashiro, O.D.

  • Optometrist
  • Monrovia, CA
National Provider Identifier
1457404147
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 12863 TPA Issued in CA
Practice address
937 W Huntington Dr
Monrovia, CA 91016-3111
Phone
(626) 357-0408
Fax
(626) 357-6768
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 12863 TPA CA Primary

Addresses

Primary practice location

937 W Huntington Dr
Monrovia, CA 91016-3111

Mailing address

937 W Huntington Dr
Monrovia, CA 91016-3111
Phone (626) 357-0408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070607000425 CA Practitioner - Optometry 0446358881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vision Quest Optometry, Inc.Group PAC ID 4880695634, 2 clinicians

Practice addresses (Care Compare)

937 W Huntington Dr
Monrovia, CA 91016-3111
Phone (626) 357-0408

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 12863 TPACAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Quest Optometry, Inc. Optometrist CurrentSince Jan 1, 2011 Accepting new patients

Locations

937 W Huntington Dr
Monrovia, CA 91016
Phone (626) 357-0408

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297036800000",
    "number": "1457404147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "937 W HUNTINGTON DR",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910163111",
            "telephone_number": "626-357-0408",
            "fax_number": "626-357-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "937 W HUNTINGTON DR",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910163111",
            "telephone_number": "626-357-0408",
            "fax_number": "626-357-6768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAMASHIRO",
        "first_name": "MARIKO",
        "middle_name": "DAWN TAKEMOTO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2011-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 12863 TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monrovia, CA

Sources for this page

Verify at the official NPI Registry.