Provider Demographics
NPI:1750551321
Name:DENNIS Y NAKATANI OD INC
Entity type:Organization
Organization Name:DENNIS Y NAKATANI OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:YUKIO
Authorized Official - Last Name:NAKATANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-775-5454
Mailing Address - Street 1:79795 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4756
Mailing Address - Country:US
Mailing Address - Phone:760-775-5454
Mailing Address - Fax:760-775-4242
Practice Address - Street 1:79795 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4756
Practice Address - Country:US
Practice Address - Phone:760-775-5454
Practice Address - Fax:760-775-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4767305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization