Provider Demographics
NPI:1043407026
Name:I-SIGHT OPTOMETRIC CENTER INC
Entity Type:Organization
Organization Name:I-SIGHT OPTOMETRIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-475-7602
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1733
Mailing Address - Country:US
Mailing Address - Phone:310-475-7602
Mailing Address - Fax:310-477-0866
Practice Address - Street 1:11600 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1733
Practice Address - Country:US
Practice Address - Phone:310-475-7602
Practice Address - Fax:310-477-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11476 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22000Medicare PIN