=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588088082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HSIEH KITAJIMA OPTOMETRY, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2014
-----------------------------------------------------
Last Update Date | 02/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 FOXWORTHY AVE. SUITE 60
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95118-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-599-2665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14A LOST VALLEY DR
-----------------------------------------------------
City | ORINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94563-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-599-2665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIAN KITAJIMA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 510-599-2665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT13358T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------