Provider Demographics
NPI:1871867358
Name:KAGEYAMA, COLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:
Last Name:KAGEYAMA
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 1:344 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0207
Mailing Address - Country:US
Mailing Address - Phone:408-376-2700
Mailing Address - Fax:408-376-2703
Practice Address - Street 1:344 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0207
Practice Address - Country:US
Practice Address - Phone:408-376-2700
Practice Address - Fax:408-376-2703
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA06707152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy