Provider Demographics
NPI:1962530709
Name:KAWAGUCHI, TRICIA S (OD)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:S
Last Name:KAWAGUCHI
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 1:1226 OLSON DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5618
Mailing Address - Country:US
Mailing Address - Phone:714-447-4034
Mailing Address - Fax:
Practice Address - Street 1:1893 W MALVERN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2403
Practice Address - Country:US
Practice Address - Phone:714-278-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12824TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist