Provider Demographics
NPI:1295212587
Name:KIMURA MCCLENAGHAN OPTOMETRICS, INC.
Entity Type:Organization
Organization Name:KIMURA MCCLENAGHAN OPTOMETRICS, INC.
Other - Org Name:AYUMI EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AYUMI
Authorized Official - Middle Name:ANGIE
Authorized Official - Last Name:KIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-430-0225
Mailing Address - Street 1:7062 HAWTHORN AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7099
Mailing Address - Country:US
Mailing Address - Phone:310-430-0225
Mailing Address - Fax:
Practice Address - Street 1:416 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-1717
Practice Address - Country:US
Practice Address - Phone:323-424-7280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13034T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty