Healthcare Provider Details

I. General information

NPI: 1508894429
Provider Name (Legal Business Name): ROBERT JAMES OKAMURA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 FERN ST
SAN DIEGO CA
92102-1137
US

IV. Provider business mailing address

1947 FERN ST
SAN DIEGO CA
92102-1137
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-6183
  • Fax: 619-232-7415
Mailing address:
  • Phone: 619-233-6183
  • Fax: 619-232-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05919-T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: