Provider Demographics
NPI:1902840796
Name:DR. WAYNE OGATA O.D. INC.
Entity Type:Organization
Organization Name:DR. WAYNE OGATA O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:KANEO
Authorized Official - Last Name:OGATA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-643-8891
Mailing Address - Street 1:4300 SONOMA BLVD
Mailing Address - Street 2:#508
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2200
Mailing Address - Country:US
Mailing Address - Phone:707-643-8891
Mailing Address - Fax:707-644-8649
Practice Address - Street 1:4300 SONOMA BLVD
Practice Address - Street 2:#508
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2200
Practice Address - Country:US
Practice Address - Phone:707-643-8891
Practice Address - Fax:707-644-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9705T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9705TOtherLICENSE
CA4015640001Medicare NSC