Provider Demographics
NPI:1962954792
Name:MITSUAKI DAVID KATO, O.D., INC.
Entity type:Organization
Organization Name:MITSUAKI DAVID KATO, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MITSUAKI
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KATO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-266-3155
Mailing Address - Street 1:12040 HAMMACK ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5922
Mailing Address - Country:US
Mailing Address - Phone:310-266-3155
Mailing Address - Fax:
Practice Address - Street 1:6000 SEPULVEDA BLVD STE 1680
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6429
Practice Address - Country:US
Practice Address - Phone:310-390-2142
Practice Address - Fax:310-397-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10896T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty