MEDICARE: DR. CLIFFORD A FUKUSHIMA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT6441T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093929085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD A FUKUSHIMA O.D.

Provider Business Mailing Address
First Line	:	5501 W HILLSDALE AVE STE D
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5159
Country	:	US
Telephone Number	:	559-625-5464
Fax Number	:	559-625-0714

Provider Business Practice Location Address
First Line	:	5501 W HILLSDALE AVE STE D
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5159
Country	:	US
Telephone Number	:	559-625-5464
Fax Number	:	559-625-0714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/09/2007

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