Provider Demographics
NPI:1538100953
Name:OGATA, WAYNE KANEO (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:KANEO
Last Name:OGATA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4300 SONOMA BLVD
Mailing Address - Street 2:#508
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2200
Mailing Address - Country:US
Mailing Address - Phone:707-643-8891
Mailing Address - Fax:707-644-8649
Practice Address - Street 1:4300 SONOMA BLVD
Practice Address - Street 2:#508
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2200
Practice Address - Country:US
Practice Address - Phone:707-643-8891
Practice Address - Fax:707-644-8649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA9705T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9705TOtherLICENSE