Healthcare Provider Details

I. General information

NPI: 1023033727
Provider Name (Legal Business Name): NANCY M HONDA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SILVER SPUR RD SUITE 101
ROLLING HILLS ESTATES CA
90274-3678
US

IV. Provider business mailing address

715 SILVER SPUR RD SUITE 101
ROLLING HILLS ESTATES CA
90274-3678
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-3779
  • Fax: 310-541-0274
Mailing address:
  • Phone: 310-541-3779
  • Fax: 310-541-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT9010T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: