Provider Demographics
NPI:1790312064
Name:OGATA, LAUREN LEIKO
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIKO
Last Name:OGATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10771 LOS ALAMITOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2309
Mailing Address - Country:US
Mailing Address - Phone:562-795-6111
Mailing Address - Fax:
Practice Address - Street 1:10771 LOS ALAMITOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2309
Practice Address - Country:US
Practice Address - Phone:562-795-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61075768152W00000X
OR4522AT152W00000X
390200000X
CA34779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program