Provider Demographics
NPI:1790424679
Name:HOSHIZAKI OPTOMETRY CENTER, INC.
Entity type:Organization
Organization Name:HOSHIZAKI OPTOMETRY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:KAI
Authorized Official - Last Name:HOSHIZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-796-8732
Mailing Address - Street 1:1310 BLACKSTONE RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 S WESTERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3816
Practice Address - Country:US
Practice Address - Phone:650-796-8732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center