Healthcare Provider Details

I. General information

NPI: 1447245188
Provider Name (Legal Business Name): RUSSELL HOSAKA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22809 HAWTHORNE BLVD
TORRANCE CA
90505-3615
US

IV. Provider business mailing address

22809 HAWTHORNE BLVD
TORRANCE CA
90505-3615
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-9993
  • Fax: 310-373-4505
Mailing address:
  • Phone: 310-373-9993
  • Fax: 310-373-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT7226TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT7226TLG
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT7226T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: