MEDICARE: TODD D MISHIMA OD

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 9700 TPA	CA

General Provider Information

NPI Number	:	1841215365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD D MISHIMA OD

Provider Business Mailing Address
First Line	:	14726 RAMONA AVE STE 203
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5730
Country	:	US
Telephone Number	:	626-305-9100
Fax Number	:	626-305-0152

Provider Business Practice Location Address
First Line	:	229 E BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3776
Country	:	US
Telephone Number	:	562-354-9522
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/25/2026

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