Provider Demographics
NPI:1104883149
Name:FUJII, JOHN KIYOSHI (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KIYOSHI
Last Name:FUJII
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W MARCH LN
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2361
Mailing Address - Country:US
Mailing Address - Phone:209-951-0820
Mailing Address - Fax:209-951-2348
Practice Address - Street 1:3133 W MARCH LN
Practice Address - Street 2:SUITE 2020
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2361
Practice Address - Country:US
Practice Address - Phone:209-951-0820
Practice Address - Fax:209-951-2348
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9652T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0096523Medicaid
CASD0096523Medicaid
CASD0096520Medicare PIN
CAP00348694Medicare PIN
CASD0096520Medicare PIN