MEDICARE: MATTHEW MAKOTO NISHIO 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	11432T	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	:	1124041801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MAKOTO NISHIO O.D.

Provider Business Mailing Address
First Line	:	6782 ALAMAR WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-6273
Country	:	US
Telephone Number	:	916-684-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 FLORIN RD
Second Line	:	SUITE 890
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2527
Country	:	US
Telephone Number	:	906-393-5151
Fax Number	:	916-392-6130

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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