MEDICARE: ROY KENJI TAKEMURA 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	5784T	CA

General Provider Information

NPI Number	:	1720165301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY KENJI TAKEMURA O.D.

Provider Business Mailing Address
First Line	:	21018 GOLDEN SPRINGS DR
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-594-3600
Fax Number	:	909-594-4264

Provider Business Practice Location Address
First Line	:	21018 GOLDEN SPRINGS DR
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-594-3600
Fax Number	:	909-594-4264

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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