Provider Demographics
NPI:1689708778
Name:KAWATA, ERIC J (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:KAWATA
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 1:30231 GOLDEN LANTERN
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5989
Mailing Address - Country:US
Mailing Address - Phone:949-495-9336
Mailing Address - Fax:949-495-9364
Practice Address - Street 1:30231 GOLDEN LANTERN
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5989
Practice Address - Country:US
Practice Address - Phone:949-495-9336
Practice Address - Fax:949-495-9364
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08259T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN317YOtherPTAN
CAFA213Medicare PIN