MEDICARE: KUBO & KUBO, O.D.S

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	152W00000X	Optometrist	5720	CA

General Provider Information

NPI Number	:	1386827087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUBO & KUBO, O.D.S

Provider Business Mailing Address
First Line	:	2409 15TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 15TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2238
Country	:	US
Telephone Number	:	916-443-8034
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DOUGLAS J. KUBO
Credential	:	O.D.
Telephone Number	:	916-443-8034

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	12/14/2009

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