Individual
DR. DENNIS WATANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4476 TWEEDY BLVD, SOUTH GATE, CA 90280-6359
(323) 563-9499
(323) 563-9056
Mailing address
75 REMITTANCE DR, DEPT 6008, CHICAGO, IL 60675-6008
(562) 282-1419
(562) 920-4642
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7702T
CA
152W00000X
Optometrist
OPT7702T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00OPT7702T0
BLUE SHIELD
CA
01
—
410046776
MEDICARE RAILROAD
CA
05
—
SD007020
—
CA
05
—
SD0077020
—
CA
Enumeration date
08/15/2006
Last updated
07/15/2016
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