Provider Demographics
NPI:1699767962
Name:MATSUNAMI, MICHAEL KATSUTO (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KATSUTO
Last Name:MATSUNAMI
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 1:301A E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3609
Mailing Address - Country:US
Mailing Address - Phone:206-464-0472
Mailing Address - Fax:206-464-0572
Practice Address - Street 1:301A E PIKE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3609
Practice Address - Country:US
Practice Address - Phone:206-464-0472
Practice Address - Fax:206-464-0572
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA061894OtherLABOR & INDUSTRY
WA2017119Medicaid
WAMA0761OtherREGENCE/BLUE SHIELD
WA2017119Medicaid