MEDICARE: DR. BETH TOSHIKO KINOSHITA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	3146T	OR

General Provider Information

NPI Number	:	1063403798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH TOSHIKO KINOSHITA O.D.

Provider Business Mailing Address
First Line	:	2043 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1756
Country	:	US
Telephone Number	:	503-352-1111
Fax Number	:	503-352-2929

Provider Business Practice Location Address
First Line	:	2043 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1756
Country	:	US
Telephone Number	:	503-352-3140
Fax Number	:	503-352-2929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/24/2009

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