Healthcare Provider Details

I. General information

NPI: 1255741468
Provider Name (Legal Business Name): LYNN WATT KURATA, OD FAAO AN OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOPT7676TPG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT7676TPG
License Number StateCA

VIII. Authorized Official

Name: LYNN WATT KURATA
Title or Position: OWNER
Credential: MS, OD, FAAO
Phone: 310-801-7045