Provider Demographics
NPI:1588088082
Name:HSIEH KITAJIMA OPTOMETRY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HSIEH KITAJIMA OPTOMETRY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITAJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-599-2665
Mailing Address - Street 1:14A LOST VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3910
Mailing Address - Country:US
Mailing Address - Phone:510-599-2665
Mailing Address - Fax:
Practice Address - Street 1:1445 FOXWORTHY AVE.
Practice Address - Street 2:SUITE 60
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1100
Practice Address - Country:US
Practice Address - Phone:510-599-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13358T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty