1154412690 NPI number — DR. KATHERINE HIROMI MORIOKA OD OPTOMETRIST

Table of content: DR. KATHERINE HIROMI MORIOKA OD OPTOMETRIST (NPI 1154412690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154412690 NPI number — DR. KATHERINE HIROMI MORIOKA OD OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORIOKA
Provider First Name:
KATHERINE
Provider Middle Name:
HIROMI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD OPTOMETRIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154412690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 BUSH ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-291-8560
Provider Business Mailing Address Fax Number:
415-291-8573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 BUSH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-291-8560
Provider Business Practice Location Address Fax Number:
415-291-8573
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT8287TPA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4404682 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0082870 . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2285200 . This is a "FIRST HEALTH CCN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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