Provider Demographics
NPI:1811972276
Name:TOMITA, KANAKO MARGARET (OD)
Entity type:Individual
Prefix:
First Name:KANAKO
Middle Name:MARGARET
Last Name:TOMITA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 BLUE RAVINE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3821
Mailing Address - Country:US
Mailing Address - Phone:916-983-1066
Mailing Address - Fax:
Practice Address - Street 1:1115 E BIDWELL ST
Practice Address - Street 2:SUITE 124
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5554
Practice Address - Country:US
Practice Address - Phone:916-983-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10174T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51829Medicare UPIN