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General NPI Number Information
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NPI Number | 1386072064
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Entity Type | Organization
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Legal Business Name | SHOJI MORITA, O.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 19000 SOLEDAD CANYON RD
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-3362
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Country | US
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Telephone | 661-251-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 19000 SOLEDAD CANYON RD
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-3362
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Country | US
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Telephone | 661-251-1400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHOJI MORITA
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Credential |
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Telephone | 661-251-1400
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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 | 13489TLG
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License Number State | CA
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