Provider Demographics
NPI:1902044548
Name:DR. DOROTHY OKAMOTO, OPTOMETRIST
Entity Type:Organization
Organization Name:DR. DOROTHY OKAMOTO, OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:TOMIYE
Authorized Official - Last Name:OKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-530-2330
Mailing Address - Street 1:3714 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1330
Mailing Address - Country:US
Mailing Address - Phone:510-530-2330
Mailing Address - Fax:510-530-4947
Practice Address - Street 1:3714 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1330
Practice Address - Country:US
Practice Address - Phone:510-530-2330
Practice Address - Fax:510-530-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0063060Medicare PIN
CAT10286Medicare UPIN