Provider Demographics
NPI:1609229780
Name:NAKATA, NICHOLE KUMIKO (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:KUMIKO
Last Name:NAKATA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROSE RIVER CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3363
Mailing Address - Country:US
Mailing Address - Phone:916-502-5709
Mailing Address - Fax:
Practice Address - Street 1:15 ROSE RIVER CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3363
Practice Address - Country:US
Practice Address - Phone:916-502-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist