Provider Demographics
NPI:1952386963
Name:ABO, JUSTIN TADASHI (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TADASHI
Last Name:ABO
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Gender:M
Credentials:OD
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Mailing Address - Street 1:12759 FOOTHILL BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9336
Mailing Address - Country:US
Mailing Address - Phone:909-899-0026
Mailing Address - Fax:909-899-6381
Practice Address - Street 1:12759 FOOTHILL BLVD
Practice Address - Street 2:STE C
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9336
Practice Address - Country:US
Practice Address - Phone:909-899-0026
Practice Address - Fax:909-899-6381
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-06-19
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Provider Licenses
StateLicense IDTaxonomies
CA11100T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist