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General NPI Number Information
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NPI Number | 1821204231
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Entity Type | Organization
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Legal Business Name | FONG NAKAMURA PARTNERSHIP
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3711 TRUXEL RD SUITE 2
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City | SACRAMENTO
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State | CA
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Zip | 95834-3610
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Country | US
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Telephone | 916-928-8383
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Fax | 916-928-8380
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Provider Business Mailing Address
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Address Line | 3711 TRUXEL RD SUITE 2
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City | SACRAMENTO
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State | CA
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Zip | 95834-3610
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Country | US
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Telephone | 916-928-8383
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Fax | 916-928-8380
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Authorized Official
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Title or Position | GENERAL PARTNER, OPTOMETRIST
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Name | DR. RYAN S NAKAMURA
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Credential | O.D.
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Telephone | 916-928-8383
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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 | 11927T
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License Number State | CA
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