Provider Demographics
NPI:1518141928
Name:DR. NORMAN TAKEDA
Entity Type:Organization
Organization Name:DR. NORMAN TAKEDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-393-7200
Mailing Address - Street 1:1325 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3618
Mailing Address - Country:US
Mailing Address - Phone:916-393-7200
Mailing Address - Fax:
Practice Address - Street 1:1325 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3618
Practice Address - Country:US
Practice Address - Phone:916-393-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6817T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004550Medicaid
CASD0068170Medicare PIN
CA1314650001Medicare NSC