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Individual
DR. TERUO WATANABE
Active
Individual
DR. TERUO WATANABE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5612T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285726877
GROUP NPI
CA
01
—
1952402026
IND. NPI
CA
05
—
SD0056120
—
CA
Enumeration date
09/25/2006
Last updated
01/14/2019
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