Organization
WOODBURY FAMILY OPTOMETRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ATSUO FUKUDA O.D. (OWNER)
(949) 786-0143
Entity
Organization
Contact information
Practice address
6270 IRVINE BLVD, IRVINE, CA 92620-2103
(949) 786-0143
(949) 786-0492
Mailing address
6270 IRVINE BLVD, IRVINE, CA 92620-2103
(949) 786-0143
(949) 786-0492
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
11134TPL
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11134TPL
CA OPTOMETRY LICENSE
CA
Enumeration date
01/20/2011
Last updated
01/20/2011
Update your record
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