Provider Demographics
NPI:1255309464
Name:OKADA, GREGG THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:THOMAS
Last Name:OKADA
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 1:946 MANHATTAN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-545-4585
Mailing Address - Fax:310-546-3240
Practice Address - Street 1:946 MANHATTAN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-545-4585
Practice Address - Fax:310-546-3240
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8296T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8296TOtherSTATE BOARD OPTOMETRY
CAM00657013OtherTHERAPEUDIC LIC #
CA8296TOtherSTATE BOARD OPTOMETRY