Provider Demographics
NPI:1346317112
Name:NAKASONE, EMERICK K (OD)
Entity Type:Individual
Prefix:
First Name:EMERICK
Middle Name:K
Last Name:NAKASONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:K
Other - Last Name:NAKASONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2390 N TUSTIN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1603
Mailing Address - Country:US
Mailing Address - Phone:714-543-3167
Mailing Address - Fax:714-835-7994
Practice Address - Street 1:2390 N TUSTIN AVE
Practice Address - Street 2:STE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1603
Practice Address - Country:US
Practice Address - Phone:714-543-3167
Practice Address - Fax:714-835-7994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7538T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U13476Medicare UPIN
CACK753AMedicare PIN