MEDICARE: DR. JASON H NAKAGAWA 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	OP9916	CA

General Provider Information

NPI Number	:	1861415481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON H NAKAGAWA O.D

Provider Business Mailing Address
First Line	:	6000 HANNUM AVE
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6504
Country	:	US
Telephone Number	:	310-365-4802
Fax Number	:	310-390-8449

Provider Business Practice Location Address
First Line	:	6000 HANNUM AVE
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6504
Country	:	US
Telephone Number	:	310-398-6900
Fax Number	:	310-390-8449

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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