Provider Demographics
NPI:1043294929
Name:HAYASHIDA, RONALD YONEO (OD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:YONEO
Last Name:HAYASHIDA
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 1:56970 YUCCA TRL
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3753
Mailing Address - Country:US
Mailing Address - Phone:760-228-2020
Mailing Address - Fax:760-369-2020
Practice Address - Street 1:56970 YUCCA TRL
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3753
Practice Address - Country:US
Practice Address - Phone:760-228-2020
Practice Address - Fax:760-369-2020
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4574T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0045740Medicaid
CAGSD004460OtherMEDICAID GROUP NUMBER
CAFU077AOtherMEDICARE GROUP NUMBER
CA1245517804OtherGROUP NPI
CASD0045741Medicare PIN
CA6685580001Medicare NSC
CA1124224589Medicare NSC
CA1245517804OtherGROUP NPI
CAFU077AOtherMEDICARE GROUP NUMBER
CASD0045740Medicaid