Provider Demographics
NPI:1356111306
Name:FUJITA, DEAN SHIGERU (LDO)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:SHIGERU
Last Name:FUJITA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 NE 130TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7709
Mailing Address - Country:US
Mailing Address - Phone:305-709-0687
Mailing Address - Fax:
Practice Address - Street 1:1425 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4624
Practice Address - Country:US
Practice Address - Phone:305-949-5670
Practice Address - Fax:305-949-5675
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5504156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician