Provider Demographics
NPI:1821021502
Name:NOMURA, CHIYOTAKA (OD)
Entity Type:Individual
Prefix:DR
First Name:CHIYOTAKA
Middle Name:
Last Name:NOMURA
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 1:5300 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2306
Mailing Address - Country:US
Mailing Address - Phone:805-692-6977
Mailing Address - Fax:805-692-6987
Practice Address - Street 1:5300 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2306
Practice Address - Country:US
Practice Address - Phone:805-692-6977
Practice Address - Fax:805-692-6987
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA006765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6607OtherMEDICAL EYE SERVICES #
CA006765TOtherOPT LISC. #
CA40937OtherDAVIS VISION ID #
CACA6765/MH67PQOtherEYEMED ID#
CASD0067650OtherBLUESHEILD ID#
MN 0667759OtherDEA #
CA40937OtherDAVIS VISION ID #
CA6607OtherMEDICAL EYE SERVICES #