Provider Demographics
NPI:1962557504
Name:NAGATANI, BRETT (OD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:NAGATANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6101 W CENTINELA AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6337
Mailing Address - Country:US
Mailing Address - Phone:310-988-1970
Mailing Address - Fax:310-988-1980
Practice Address - Street 1:6101 W CENTINELA AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6337
Practice Address - Country:US
Practice Address - Phone:310-988-1970
Practice Address - Fax:310-988-1980
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13050T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist