Provider Demographics
NPI:1467485185
Name:LUM-KAWASAKI, CINDY F (OD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:F
Last Name:LUM-KAWASAKI
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 1:6555 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2796
Mailing Address - Country:US
Mailing Address - Phone:702-396-5775
Mailing Address - Fax:
Practice Address - Street 1:6555 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2796
Practice Address - Country:US
Practice Address - Phone:702-233-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11453T152W00000X
NV613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO114530Medicaid
CAU87076Medicare UPIN
CASDO114530Medicaid