Provider Demographics
NPI:1821072133
Name:NAKANO, MARK EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:NAKANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4201 TORRANCE BLVD.
Mailing Address - Street 2:SUITE 580
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-316-6726
Mailing Address - Fax:310-316-6856
Practice Address - Street 1:4201 TORRANCE BLVD.
Practice Address - Street 2:SUITE 580
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-316-6726
Practice Address - Fax:310-316-6856
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA8818TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T70289Medicare UPIN