Individual
DR. GORDON KIYOSHI OTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
10130 WARNER AVE, SUITE J, FOUNTAIN VALLEY, CA 92708-1619
(714) 965-5130
Mailing address
10130 WARNER AVE, SUITE J, FOUNTAIN VALLEY, CA 92708-1619
(714) 965-5130
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T7549
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0075490
—
CA
Enumeration date
01/27/2006
Last updated
09/05/2012
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