Provider Demographics
NPI:1447245188
Name:HOSAKA, RUSSELL (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:HOSAKA
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 1:22809 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3615
Mailing Address - Country:US
Mailing Address - Phone:310-373-9993
Mailing Address - Fax:310-373-4505
Practice Address - Street 1:22809 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3615
Practice Address - Country:US
Practice Address - Phone:310-373-9993
Practice Address - Fax:310-373-4505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7226TLG152W00000X, 152WC0802X
CAOPT7226T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45536OtherSAFEGUARD
CA3103739993OtherVSP
AR03164OtherEYE CARE NETWORK
CACA7226OtherEYEMED
CA3103739993OtherVSP
CA45536OtherSAFEGUARD