Provider Demographics
NPI:1629047527
Name:OKAMOTO, DOROTHY T (OD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:T
Last Name:OKAMOTO
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 1:3714 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1330
Mailing Address - Country:US
Mailing Address - Phone:510-530-2330
Mailing Address - Fax:510-530-4947
Practice Address - Street 1:3714 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1330
Practice Address - Country:US
Practice Address - Phone:510-530-2330
Practice Address - Fax:510-530-4947
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABN684AMedicare PIN
CA3676770001Medicare NSC