Provider Demographics
NPI:1548512874
Name:KITAMORI, VALERIE SACHIKO (OD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:SACHIKO
Last Name:KITAMORI
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 1:15645 AVENIDA ALCACHOFA APT D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4442
Mailing Address - Country:US
Mailing Address - Phone:808-896-6214
Mailing Address - Fax:
Practice Address - Street 1:73-5600 MAIAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2630
Practice Address - Country:US
Practice Address - Phone:808-331-8081
Practice Address - Fax:808-331-8082
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33362152W00000X
WAOD60574434152W00000X
HIOD-830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIOD-830OtherMEDICAL LICENSE