Healthcare Provider Details

I. General information

NPI: 1316618481
Provider Name (Legal Business Name): KATE MURAMOTO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N ROBERTSON BLVD
BEVERLY HILLS CA
90211-1769
US

IV. Provider business mailing address

1528 SE 41ST LOOP
HILLSBORO OR
97123-7541
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3450
  • Fax:
Mailing address:
  • Phone: 818-836-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4600
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: