Provider Demographics
NPI:1811961188
Name:NODA, DENNIS KAZUO (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KAZUO
Last Name:NODA
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 1:8931 ATLANTA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7121
Mailing Address - Country:US
Mailing Address - Phone:714-960-4330
Mailing Address - Fax:714-536-6669
Practice Address - Street 1:8931 ATLANTA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7121
Practice Address - Country:US
Practice Address - Phone:714-960-4330
Practice Address - Fax:714-536-6669
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5313T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T70006Medicare UPIN