Provider Demographics
NPI:1992169049
Name:NAKAJIMA, KASEY NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:KASEY
Middle Name:NICOLE
Last Name:NAKAJIMA
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 1:1626 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1612
Mailing Address - Country:US
Mailing Address - Phone:831-233-2077
Mailing Address - Fax:
Practice Address - Street 1:21 UPPER RAGSDALE DR STE 200
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7858
Practice Address - Country:US
Practice Address - Phone:831-372-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34096TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist