Provider Demographics
NPI:1093929085
Name:FUKUSHIMA, CLIFFORD A (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:A
Last Name:FUKUSHIMA
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 1:5501 W HILLSDALE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5159
Mailing Address - Country:US
Mailing Address - Phone:559-625-5464
Mailing Address - Fax:559-625-0714
Practice Address - Street 1:5501 W HILLSDALE AVE STE D
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5159
Practice Address - Country:US
Practice Address - Phone:559-625-5464
Practice Address - Fax:559-625-0714
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6441T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0064410Medicaid
P00083170Medicare ID - Type UnspecifiedRAILROARD MEDICARE
5081820001Medicare NSC
CASD0064410Medicaid
T10322Medicare UPIN