MEDICARE: DR. JOHN IWAO KIKUCHI 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	152W00000X	Optometrist	3689	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437143922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN IWAO KIKUCHI O.D.

Provider Business Mailing Address
First Line	:	6125 S KEPPLER ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-5918
Country	:	US
Telephone Number	:	206-850-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	677 S JACKSON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2928
Country	:	US
Telephone Number	:	206-623-1100
Fax Number	:	206-624-0463

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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