Provider Demographics
NPI:1861415481
Name:NAKAGAWA, JASON H (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:H
Last Name:NAKAGAWA
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 1:6000 HANNUM AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6504
Mailing Address - Country:US
Mailing Address - Phone:310-365-4802
Mailing Address - Fax:310-390-8449
Practice Address - Street 1:6000 HANNUM AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6504
Practice Address - Country:US
Practice Address - Phone:310-398-6900
Practice Address - Fax:310-390-8449
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP9916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist