MEDICARE: DR. DOROTHY T OKAMOTO 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	6306	CA

General Provider Information

NPI Number	:	1629047527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY T OKAMOTO O.D.

Provider Business Mailing Address
First Line	:	3714 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-1330
Country	:	US
Telephone Number	:	510-530-2330
Fax Number	:	510-530-4947

Provider Business Practice Location Address
First Line	:	3714 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-1330
Country	:	US
Telephone Number	:	510-530-2330
Fax Number	:	510-530-4947

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/02/2009

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