MEDICARE: DR. KEVIN KAORU HIRANO 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	9397 T	CA

General Provider Information

NPI Number	:	1144211996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN KAORU HIRANO O.D.

Provider Business Mailing Address
First Line	:	3185 OLD CONEJO RD
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2151
Country	:	US
Telephone Number	:	805-499-0454
Fax Number	:	805-499-8314

Provider Business Practice Location Address
First Line	:	3185 OLD CONEJO RD
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2151
Country	:	US
Telephone Number	:	805-499-0454
Fax Number	:	805-499-8314

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

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	05/01/2014

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