Provider Demographics
NPI:1851441539
Name:ITO, VIOLET ANNE (OD)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:ANNE
Last Name:ITO
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 1:321 WILSHIRE BLVD
Mailing Address - Street 2:C O EYEXAM OF CA.
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1311
Mailing Address - Country:US
Mailing Address - Phone:310-394-2127
Mailing Address - Fax:
Practice Address - Street 1:1815 HAWTHORNE BLVD
Practice Address - Street 2:STE 236 GALLERIA AT SOUTH BAY
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3424
Practice Address - Country:US
Practice Address - Phone:310-370-1618
Practice Address - Fax:310-371-3126
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7822T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13933Medicare UPIN
CAWOP7822BMedicare ID - Type Unspecified