Healthcare Provider Details

I. General information

NPI: 1841225158
Provider Name (Legal Business Name): LYNN WATT KURATA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 7TH ST STE 2
SANTA MONICA CA
90401-1614
US

IV. Provider business mailing address

1234 7TH ST STE 2
SANTA MONICA CA
90401-1614
US

V. Phone/Fax

Practice location:
  • Phone: 310-395-5778
  • Fax: 310-458-9754
Mailing address:
  • Phone: 310-395-5778
  • Fax: 310-458-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT7676TPG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT7676TPG
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT7676TPG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: