Provider Demographics
NPI:1528116167
Name:KURATA, STEVEN K (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:KURATA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 3RD ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1644
Mailing Address - Country:US
Mailing Address - Phone:213-680-1551
Mailing Address - Fax:213-680-2148
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:SUITE 603
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1644
Practice Address - Country:US
Practice Address - Phone:213-680-1551
Practice Address - Fax:213-680-2148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP5722152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057223Medicaid
CASD0057220Medicaid
CASD0057222Medicaid
CASD0057223Medicaid