Provider Demographics
NPI:1316938780
Name:NAKANO, MILTON M (OD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:M
Last Name:NAKANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 W LINCOLN AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6334
Mailing Address - Country:US
Mailing Address - Phone:714-527-5060
Mailing Address - Fax:714-527-5073
Practice Address - Street 1:2795 W LINCOLN AVE
Practice Address - Street 2:SUITE L
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6334
Practice Address - Country:US
Practice Address - Phone:714-527-5060
Practice Address - Fax:714-527-5073
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA5744TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057440Medicaid
CAY7679Medicare PIN
CAT70059Medicare UPIN
CASD0057440Medicaid