Provider Demographics
NPI:1841298247
Name:NAKAJIMA, GRANT A
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:A
Last Name:NAKAJIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARRIS CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5798
Mailing Address - Country:US
Mailing Address - Phone:831-375-5141
Mailing Address - Fax:
Practice Address - Street 1:4 HARRIS CT
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5798
Practice Address - Country:US
Practice Address - Phone:831-375-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT09053T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10024Medicare UPIN
CA0324620001Medicare NSC
CASD009050Medicare PIN