Provider Demographics
NPI:1427114081
Name:KUMATA, WENDY MAYUMI (OD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MAYUMI
Last Name:KUMATA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 S VICTORIA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6550
Mailing Address - Country:US
Mailing Address - Phone:805-644-1134
Mailing Address - Fax:
Practice Address - Street 1:3875 TELEGRAPH RD
Practice Address - Street 2:SUITE D
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3419
Practice Address - Country:US
Practice Address - Phone:805-644-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10356TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10356Medicare PIN
CA1197260001Medicare NSC
CAU67473Medicare UPIN