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General NPI Number Information
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NPI Number | 1073550976
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Entity Type | Individual
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Provider Name | HERBERT KEIJI WAKAMATSU OD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 3525 W 8TH ST #228B
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City | LOS ANGELES
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State | CA
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Zip | 90005-2993
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Country | US
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Telephone | 213-380-2831
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Fax | 213-384-2002
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Provider Business Mailing Address
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Address Line | 16302 HEARTWOOD CT
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City | LA MIRADA
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State | CA
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Zip | 90638-6516
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Country | US
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Telephone | 562-279-5406
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Fax | 213-384-2002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5224T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT 5224T
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License Number State | CA
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