Provider Demographics
NPI:1841225158
Name:KURATA, LYNN WATT (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:WATT
Last Name:KURATA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 7TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1614
Mailing Address - Country:US
Mailing Address - Phone:310-395-5778
Mailing Address - Fax:310-458-9754
Practice Address - Street 1:1234 7TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1614
Practice Address - Country:US
Practice Address - Phone:310-395-5778
Practice Address - Fax:310-458-9754
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7676TPG152WL0500X, 152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0076760Medicaid
CASD0076762Medicaid
CASD0076761Medicaid
CASD0076763Medicaid
CASD0076760Medicaid
CAOP7676BMedicare ID - Type UnspecifiedWEST LOS ANGELES
CASD0076762Medicaid
CAOP7676Medicare ID - Type UnspecifiedLOS ANGELES