Provider Demographics
NPI:1124179254
Name:TARI, MILTON MITSUYOSHI (OD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:MITSUYOSHI
Last Name:TARI
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 1:192 FOX HILLS MALL
Mailing Address - Street 2:C O EYEXAM
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6402
Mailing Address - Country:US
Mailing Address - Phone:310-329-7147
Mailing Address - Fax:
Practice Address - Street 1:195 SANTA MONICA PL
Practice Address - Street 2:#195
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2364
Practice Address - Country:US
Practice Address - Phone:310-576-6023
Practice Address - Fax:310-393-3883
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9370T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13930Medicare UPIN
CAWOP9370Medicare ID - Type Unspecified