Provider Demographics
NPI:1255328555
Name:BABA, STEPHANIE NISHIMURA (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NISHIMURA
Last Name:BABA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MCDONNEL RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-7748
Mailing Address - Country:US
Mailing Address - Phone:510-865-9095
Mailing Address - Fax:510-880-0500
Practice Address - Street 1:401 MCDONNEL RD
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-7748
Practice Address - Country:US
Practice Address - Phone:510-865-9095
Practice Address - Fax:510-880-0500
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6525T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0065250Medicare UPIN
CASD0065250Medicare ID - Type Unspecified