Provider Demographics
NPI:1194843318
Name:COZIE N KANEMARU & ROSEMARY HUM PTR
Entity Type:Organization
Organization Name:COZIE N KANEMARU & ROSEMARY HUM PTR
Other - Org Name:KANEMARU AND HUM, OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-791-0229
Mailing Address - Street 1:22330 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2536
Mailing Address - Country:US
Mailing Address - Phone:310-791-0229
Mailing Address - Fax:
Practice Address - Street 1:22330 HAWTHORNE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2536
Practice Address - Country:US
Practice Address - Phone:310-791-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7963 TPA152W00000X
CAOPT 7973 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0954310001Medicare NSC
CAWY3750Medicare ID - Type UnspecifiedGROUP NUMBER