Provider Demographics
NPI:1083607527
Name:SAKUMA, STUART MAKOTO (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:MAKOTO
Last Name:SAKUMA
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 1:1858 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3092
Mailing Address - Country:US
Mailing Address - Phone:831-724-2258
Mailing Address - Fax:
Practice Address - Street 1:1858 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3092
Practice Address - Country:US
Practice Address - Phone:831-724-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2021-10-27
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAOPT10730TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107300Medicare ID - Type Unspecified