Healthcare Provider Details

I. General information

NPI: 1992169049
Provider Name (Legal Business Name): KASEY NICOLE NAKAJIMA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 UPPER RAGSDALE DR STE 200
MONTEREY CA
93940-7858
US

IV. Provider business mailing address

1626 22ND AVE
FOREST GROVE OR
97116-1612
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-1500
  • Fax:
Mailing address:
  • Phone: 831-233-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34096TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: