MEDICARE: AUSTIN NAKATSUKA M.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	207W00000X	Ophthalmology Physician	11213695-1205	UT

General Provider Information

NPI Number	:	1366821688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN NAKATSUKA M.D.

Provider Business Mailing Address
First Line	:	65 S MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 S MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2409
Country	:	US
Telephone Number	:	801-585-6701
Fax Number	:	801-581-5806

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	11/08/2021

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