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Individual

DR. RICARDO FUKUZATO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
11720 MEDLOCK BRIDGE RD, SUITE 140, JOHNS CREEK, GA 30097-1509
(770) 495-7898
Mailing address
11103 WEST AVE, SAN ANTONIO, TX 78213-1338
(812) 285-5050

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
12991T
CA
152W00000X
Optometrist
Primary
OPT002431
GA

Other

Enumeration date
03/01/2007
Last updated
01/12/2009
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