Healthcare Provider Details

I. General information

NPI: 1528134624
Provider Name (Legal Business Name): TERA NAKANO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 JACKSON ST
SAN JOSE CA
95112-3201
US

IV. Provider business mailing address

2840 PRUNERIDGE AVE
SANTA CLARA CA
95051-5651
US

V. Phone/Fax

Practice location:
  • Phone: 408-293-3730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: