Provider Demographics
NPI:1033307798
Name:NISHIMOTO, JANIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:
Last Name:NISHIMOTO
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 1:2100 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3702
Mailing Address - Country:US
Mailing Address - Phone:714-637-5253
Mailing Address - Fax:714-637-3808
Practice Address - Street 1:2100 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3702
Practice Address - Country:US
Practice Address - Phone:714-637-5253
Practice Address - Fax:714-637-3808
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10234 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist