Provider Demographics
NPI:1336135888
Name:CLIFFORD A FUKUSHIMA OD INC
Entity Type:Organization
Organization Name:CLIFFORD A FUKUSHIMA OD INC
Other - Org Name:INTEGRATED VISION CARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:AIKO
Authorized Official - Last Name:FUKUSHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-625-5464
Mailing Address - Street 1:5501 W HILLSDALE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5159
Mailing Address - Country:US
Mailing Address - Phone:559-625-5464
Mailing Address - Fax:559-625-0714
Practice Address - Street 1:5501 W HILLSDALE AVE
Practice Address - Street 2:STE D
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5159
Practice Address - Country:US
Practice Address - Phone:559-625-5464
Practice Address - Fax:559-625-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6441T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00083170OtherMEDICARE RAILROAD
CASD0064410Medicaid
T10322Medicare UPIN
CA5081820001Medicare NSC
ZZZ26544ZMedicare ID - Type Unspecified