Provider Demographics
NPI:1851410773
Name:CERRITOS 2020 OPTOMETRY, A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:CERRITOS 2020 OPTOMETRY, A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:DR. DARLYNE H FUJIMOTO, OD & ASSOCIATES, APC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDO-LANGIT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-860-1339
Mailing Address - Street 1:11420 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-860-1339
Mailing Address - Fax:562-860-6959
Practice Address - Street 1:11420 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-860-1339
Practice Address - Fax:562-860-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70228Medicare UPIN
CAWY053Medicare PIN