Provider Demographics
NPI:1912034786
Name:FUJIMOTO, DARLYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DARLYNE
Middle Name:
Last Name:FUJIMOTO
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 1:11420 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6611
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:90703-6611
Practice Address - Country:US
Practice Address - Phone:562-860-1339
Practice Address - Fax:562-860-6959
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70228Medicare UPIN
CAWOP7820AMedicare PIN