Provider Demographics
NPI:1801059365
Name:DRS. OMOTO AND OMOTO
Entity type:Organization
Organization Name:DRS. OMOTO AND OMOTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:OMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-421-1278
Mailing Address - Street 1:7248 S LAND PARK DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3660
Mailing Address - Country:US
Mailing Address - Phone:916-421-1278
Mailing Address - Fax:916-421-5055
Practice Address - Street 1:7248 S LAND PARK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3660
Practice Address - Country:US
Practice Address - Phone:916-421-1278
Practice Address - Fax:916-421-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-04
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty