Provider Demographics
NPI:1598737553
Name:NATSUMEDA, NEAL H (OD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:H
Last Name:NATSUMEDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3326
Mailing Address - Country:US
Mailing Address - Phone:310-374-0012
Mailing Address - Fax:310-379-3515
Practice Address - Street 1:419 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3326
Practice Address - Country:US
Practice Address - Phone:310-374-0012
Practice Address - Fax:310-379-3515
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8294 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7130029Medicaid
OP 8294Medicare ID - Type Unspecified
CA7130029Medicaid