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General NPI Number Information
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NPI Number | 1851404040
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Entity Type | Individual
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Provider Name | DENNIS WATANABE O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 4476 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6359
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Country | US
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Telephone | 323-563-9499
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Fax | 323-563-9056
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Provider Business Mailing Address
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Address Line | 75 REMITTANCE DR DEPT 6008
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City | CHICAGO
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State | IL
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Zip | 60675-6008
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Country | US
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Telephone | 562-282-1419
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Fax | 562-920-4642
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT7702T
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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 | 7702T
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License Number State | CA
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