Provider Demographics
NPI:1558438150
Name:NARAHARA, ROBERT K (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:NARAHARA
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1844
Mailing Address - Country:US
Mailing Address - Phone:559-592-3121
Mailing Address - Fax:559-592-3766
Practice Address - Street 1:400 E PINE ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1844
Practice Address - Country:US
Practice Address - Phone:559-592-3121
Practice Address - Fax:559-592-3766
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5441TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669658167OtherGROUP NIP
CA6276614Medicaid
CABT208ZMedicare PIN
CABT122AMedicare PIN
CA1669658167OtherGROUP NIP
CA0386040001Medicare NSC
CA6276614Medicaid