Provider Demographics
NPI:1184008294
Name:NANCY T IMAMOTO OD PC
Entity Type:Organization
Organization Name:NANCY T IMAMOTO OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-329-4128
Mailing Address - Street 1:1713 W ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3220
Mailing Address - Country:US
Mailing Address - Phone:310-329-4128
Mailing Address - Fax:310-329-9180
Practice Address - Street 1:1713 W ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3220
Practice Address - Country:US
Practice Address - Phone:310-329-4128
Practice Address - Fax:310-329-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty