Provider Demographics
NPI:1710054853
Name:OMOTO, STEVEN G (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:OMOTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7410 GREENHAVEN DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5158
Mailing Address - Country:US
Mailing Address - Phone:916-421-1278
Mailing Address - Fax:916-421-5055
Practice Address - Street 1:7410 GREENHAVEN DR
Practice Address - Street 2:SUITE 140
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5158
Practice Address - Country:US
Practice Address - Phone:916-421-1278
Practice Address - Fax:916-421-5055
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6310TPA152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0063100Medicaid
CAT10288Medicare UPIN
CA0513020001Medicare NSC