Provider Demographics
NPI:1275509713
Name:MURATA, NELSON (OD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MURATA
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 1:3885 COCHRAN STREET
Mailing Address - Street 2:UNIT L
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2369
Mailing Address - Country:US
Mailing Address - Phone:805-522-7007
Mailing Address - Fax:805-522-7886
Practice Address - Street 1:3885 COCHRAN STREET
Practice Address - Street 2:UNIT L
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2369
Practice Address - Country:US
Practice Address - Phone:805-522-7007
Practice Address - Fax:805-522-7886
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7290T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76549Medicare UPIN
CAOP7290Medicare ID - Type Unspecified
CA1306160001Medicare NSC