Provider Demographics
NPI:1659397123
Name:SUGIMURA, JOY NAOMI (OD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:NAOMI
Last Name:SUGIMURA
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 1:4325 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4715
Mailing Address - Country:US
Mailing Address - Phone:510-547-5525
Mailing Address - Fax:510-547-3787
Practice Address - Street 1:4325 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4715
Practice Address - Country:US
Practice Address - Phone:510-547-5525
Practice Address - Fax:510-547-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6567T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU39940Medicare UPIN
CASD0065670Medicare ID - Type Unspecified