Ota, Gordon Kiyoshi

Ota, Gordon Kiyoshi is an individual health care provider with primary practice located at 10130 Warner Ave Suite J, Fountain Valley CA 92708-1619. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ota, Gordon Kiyoshi can be contacted via phone (714) 965-5130.

Contact Information

Primary practice address
10130 Warner Ave Suite J Fountain Valley CA 92708-1619
Phone: (714) 965-5130
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X T7549 California

Profile Details

NPI number 1154392470
LBN Legal business name Ota, Gordon Kiyoshi
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated Sep 5th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154392470 NPPES
California MEDICAID SD0075490

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