MEDICARE: MARVIN S. NAKAMOTO 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	OPT 8551 TPA	CA
2	152W00000X	Optometrist	8551	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
2	02813	OTHER	CA	MEDICAL EYE SERVICES

General Provider Information

NPI Number	:	1437297173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN S. NAKAMOTO O.D.

Provider Business Mailing Address
First Line	:	2131 CAPITOL AVE
Second Line	:	SUITE 107
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5755
Country	:	US
Telephone Number	:	916-446-0125
Fax Number	:	916-446-3586

Provider Business Practice Location Address
First Line	:	2131 CAPITOL AVE
Second Line	:	SUITE 107
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5755
Country	:	US
Telephone Number	:	916-446-0125
Fax Number	:	916-446-3586

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	03/31/2017

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