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Organization
MARSHALL B. KETCHUM UNIVERSITY
Active
Organization
MARSHALL B. KETCHUM UNIVERSITY
Active
Other names
University Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK NAKANO O.D. (ASSOCIATE DEAN OF CLINICS)
(714) 463-7504
Entity
Organization
Contact information
Practice address
5460 E LA PALMA AVE, ANAHEIM, CA 92807-2023
(714) 463-7500
(714) 992-7811
Mailing address
5460 E LA PALMA AVE, ANAHEIM, CA 92807-2023
(714) 463-7500
(714) 992-7811
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP8428
RAILROAD
CA
05
—
ZZT11708F
—
CA
Enumeration date
04/06/2007
Last updated
09/20/2016
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