Dr. Ricardo Fukuzato, O.D.
Optometrist in Johns Creek, GA. Individual provider (NPI-1).
NPI number1013045368
StatusActive
Last updated in NPPESJan 12, 2009
Details
- NPI
- 1013045368
- Entity type
- Individual (NPI-1)
- Name
- Dr. Ricardo Fukuzato
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 1, 2007
- Last updated
- Jan 12, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | OPT002431 | GA | Yes |
| 152W00000X | Optometrist | 12991T | CA |
Practice location
11720 Medlock Bridge RdSuite 140
Johns Creek, GA 30097-1509
Phone 770-495-7898
Mailing address
11103 West AveSan Antonio, TX 78213-1338
Phone 812-285-5050
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