Provider Demographics
NPI:1538297668
Name:TAKAHASHI, MASAKAZU MIKE (OPTOMETRIST OD)
Entity Type:Individual
Prefix:MR
First Name:MASAKAZU
Middle Name:MIKE
Last Name:TAKAHASHI
Suffix:
Gender:M
Credentials:OPTOMETRIST OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7246 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1935
Mailing Address - Country:US
Mailing Address - Phone:510-235-6358
Mailing Address - Fax:510-235-6358
Practice Address - Street 1:829 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4306
Practice Address - Country:US
Practice Address - Phone:510-465-5876
Practice Address - Fax:510-238-5164
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist