Provider Demographics
NPI:1811961402
Name:MATSUDA, LYNN KATO (OD FAAO)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:KATO
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:OD FAAO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:250 EAST 1ST ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3875
Mailing Address - Country:US
Mailing Address - Phone:213-628-7419
Mailing Address - Fax:213-620-9110
Practice Address - Street 1:250 EAST 1ST ST
Practice Address - Street 2:SUITE 802
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3875
Practice Address - Country:US
Practice Address - Phone:213-628-7419
Practice Address - Fax:213-620-9110
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9488T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP9488BOtherPTAN
CAWOP9488BOtherPTAN