Provider Demographics
NPI:1831107762
Name:JA, STEVEN K (OD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:K
Last Name:JA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6780 MEADOW VISTA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135
Mailing Address - Country:US
Mailing Address - Phone:408-239-1167
Mailing Address - Fax:
Practice Address - Street 1:2180 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-235-1167
Practice Address - Fax:408-531-1123
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9463T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094630Medicaid