Provider Demographics
NPI:1841215365
Name:MISHIMA, TODD D (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:MISHIMA
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 1:2446 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3041
Mailing Address - Country:US
Mailing Address - Phone:323-728-5500
Mailing Address - Fax:323-728-4408
Practice Address - Street 1:2446 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3041
Practice Address - Country:US
Practice Address - Phone:323-728-5500
Practice Address - Fax:323-728-4408
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9700 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0610180005Medicare NSC
0610180004Medicare NSC
0610180001Medicare NSC
CAU56288Medicare UPIN
0610180003Medicare NSC
0610180002Medicare NSC