Provider Demographics
NPI:1508997354
Name:OKURA, DARLENE TAEKO (OD)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:TAEKO
Last Name:OKURA
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 1:3505 SONOMA BLVD
Mailing Address - Street 2:SUITE #30
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2920
Mailing Address - Country:US
Mailing Address - Phone:707-643-1003
Mailing Address - Fax:
Practice Address - Street 1:3505 SONOMA BLVD
Practice Address - Street 2:SUITE #30
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2920
Practice Address - Country:US
Practice Address - Phone:707-643-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9329T152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0093290Medicaid
CASD0093290Medicaid
CASD0093290Medicare ID - Type Unspecified