Provider Demographics
NPI:1255741468
Name:LYNN WATT KURATA, OD FAAO , AN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:LYNN WATT KURATA, OD FAAO , AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:WATT
Authorized Official - Last Name:KURATA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-801-7045
Mailing Address - Street 1:1234 7TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1614
Mailing Address - Country:US
Mailing Address - Phone:310-395-5778
Mailing Address - Fax:310-458-9754
Practice Address - Street 1:1234 7TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1614
Practice Address - Country:US
Practice Address - Phone:310-395-5778
Practice Address - Fax:310-458-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7676TPG332H00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTAN 7394100001OtherNSC DMEPOS
CASD0076763Medicaid
CAPTAN 7394100001OtherNSC DMEPOS
CASD0076763Medicaid