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General NPI Number Information
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NPI Number | 1811124316
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Entity Type | Organization
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Legal Business Name | KEITH KOSAKURA, O.D.
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 19998 HOMESTEAD RD SUITE E
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City | CUPERTINO
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State | CA
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Zip | 95014-0569
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Country | US
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Telephone | 408-257-5262
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Fax | 408-257-8271
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Provider Business Mailing Address
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Address Line | 19998 HOMESTEAD RD SUITE E
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City | CUPERTINO
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State | CA
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Zip | 95014-0569
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Country | US
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Telephone | 408-257-5262
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Fax | 408-257-8271
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH H KOSAKURA
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Credential | O.D.
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Telephone | 408-257-5262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 10854 T
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License Number State | CA
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