Provider Demographics
NPI:1760462956
Name:OKAMOTO, JOHN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:OKAMOTO
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Gender:M
Credentials:OD
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Mailing Address - Street 1:9221 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5919
Mailing Address - Country:US
Mailing Address - Phone:916-797-6747
Mailing Address - Fax:916-797-6728
Practice Address - Street 1:9221 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5919
Practice Address - Country:US
Practice Address - Phone:916-797-6747
Practice Address - Fax:916-797-6728
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-05-21
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Provider Licenses
StateLicense IDTaxonomies
CA9831T152W00000X, 152WC0802X, 152WS0006X, 152WX0102X
CA9831 TPA152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005440Medicaid
CASD0098311OtherPPIN #
CAU77101Medicare UPIN
CAGSD005440Medicaid