Provider Demographics
NPI:1306339841
Name:FUKUZATO EYECARE, INC
Entity type:Organization
Organization Name:FUKUZATO EYECARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUKUZATO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-807-7482
Mailing Address - Street 1:3670 HUTCHINSON RD STE A&B
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5902
Mailing Address - Country:US
Mailing Address - Phone:678-807-7482
Mailing Address - Fax:678-807-7243
Practice Address - Street 1:3670 HUTCHINSON RD STE A&B
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-899-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-09
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty