Healthcare Provider Details

I. General information

NPI: 1801059365
Provider Name (Legal Business Name): DRS. OMOTO AND OMOTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 07/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 S LAND PARK DR SUITE 204
SACRAMENTO CA
95831-3660
US

IV. Provider business mailing address

7248 S LAND PARK DR SUITE 204
SACRAMENTO CA
95831-3660
US

V. Phone/Fax

Practice location:
  • Phone: 916-421-1278
  • Fax: 916-421-5055
Mailing address:
  • Phone: 916-421-1278
  • Fax: 916-421-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN G. OMOTO
Title or Position: OWNER
Credential: O.D.
Phone: 916-421-1278