Individual provider Active NPI

Keith Uyemura, OD

  • Optometrist
  • Berkeley, CA
National Provider Identifier
1497641096
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
36012 Issued in CA
Practice address
200 Minor Hall
Berkeley, CA 94720-0001
Phone
(510) 642-2020
NPI assigned
Jun 18, 2025
Last updated
Jun 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 36012 CA Primary

Addresses

Primary practice location

200 Minor Hall
Berkeley, CA 94720-0001

Mailing address

1333 Padres TRL
La Canada, CA 91011-3131
Phone (818) 309-7115

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
I20251001004074 CA Practitioner - Optometry 4284130907 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of California at BerkeleyGroup PAC ID 8628083110, 57 clinicians

Practice addresses (Care Compare)

200 Minor Hall
Suite 384a
Berkeley, CA 94720-2020
Phone (510) 642-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36012CAMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California at Berkeley Optometrist CurrentSince Jul 1, 2025 Accepting new patients

Locations

200 Minor Hall
Berkeley, CA 94720
Phone (510) 642-0945

200 Minor Hall
Ste 384A
Berkeley, CA 94720
Phone (510) 642-7844

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1497641096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 PADRES TRL",
            "city": "LA CANADA",
            "state": "CA",
            "postal_code": "910113131",
            "telephone_number": "818-309-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MINOR HALL",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947200001",
            "telephone_number": "510-642-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UYEMURA",
        "first_name": "KEITH",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "36012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.