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General NPI Number Information
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NPI Number | 1427185990
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Entity Type | Organization
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Legal Business Name | RICHARD J. MIYAMOTO, O.D
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 18525 S WESTERN AVE
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City | GARDENA
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State | CA
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Zip | 90248-3830
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Country | US
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Telephone | 310-538-3937
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Fax | 310-538-6952
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Provider Business Mailing Address
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Address Line | 18525 S WESTERN AVE
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City | GARDENA
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State | CA
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Zip | 90248-3830
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Country | US
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Telephone | 310-538-3937
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Fax | 310-538-6952
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RICHARD J MIYAMOTO
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Credential | O.D.
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Telephone | 310-538-3937
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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 | 10386TPA
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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 | 11361TPA
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7016TPA
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License Number State | CA
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