Provider Demographics
NPI:1023033727
Name:HONDA, NANCY M (OD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:HONDA
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 1:715 SILVER SPUR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3678
Mailing Address - Country:US
Mailing Address - Phone:310-541-3779
Mailing Address - Fax:310-541-0274
Practice Address - Street 1:715 SILVER SPUR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3678
Practice Address - Country:US
Practice Address - Phone:310-541-3779
Practice Address - Fax:310-541-0274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9010T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U42193Medicare UPIN
CABP553ZMedicare PIN
CA0807250001Medicare NSC