Provider Demographics
NPI:1063500619
Name:LYNN WATT KURATA OD, FAAO INC
Entity Type:Organization
Organization Name:LYNN WATT KURATA OD, FAAO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:WATT
Authorized Official - Last Name:KURATA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OD, FAAO
Authorized Official - Phone:310-453-0489
Mailing Address - Street 1:1950 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-453-0886
Practice Address - Street 1:1950 SAWTELLE BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7014
Practice Address - Country:US
Practice Address - Phone:310-453-0489
Practice Address - Fax:310-453-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP7676T152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD76763Medicaid
CASD76762Medicaid
CASD0076760Medicaid
CASD0076761Medicaid
CASD0076760Medicaid
CAU38000Medicare UPIN
CAOP7676BMedicare ID - Type Unspecified
CASD76762Medicaid