Provider Demographics
NPI:1316709777
Name:JEFFREY IWAMI, OD, INC
Entity type:Organization
Organization Name:JEFFREY IWAMI, OD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:IWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-836-4100
Mailing Address - Street 1:6650 HEMBREE LN
Mailing Address - Street 2:INSIDE THE VISION CENTER
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6650 HEMBREE LN
Practice Address - Street 2:INSIDE THE VISION CENTER
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492
Practice Address - Country:US
Practice Address - Phone:707-836-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty