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Individual

DR. BEVERLY NISHITANI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
417 N EUCLID AVE, ONTARIO, CA 91762-3427
(909) 986-9951
(909) 986-9812
Mailing address
417 N EUCLID AVE, ONTARIO, CA 91762-3427
(909) 986-9951
(909) 986-9812

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10183T
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2480
DAVIS VISION PIN
CA
01
9V12089
INDIVIDUAL IEHP PIN
CA
05
SD0101830
CA
Enumeration date
02/28/2006
Last updated
03/30/2020
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