Basic Information
Provider Information
NPI: 1922156835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AOTO
FirstName: RODNEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 393 E WALNUT ST
Address2: 3RD FLOOR PHR SYSTEMS
City: PASADENA
State: CA
PostalCode: 911880001
CountryCode: US
TelephoneNumber: 0000000000
FaxNumber: 0000000000
Practice Location
Address1: 25825 VERMONT AVE
Address2:  
City: HARBOR CITY
State: CA
PostalCode: 907103518
CountryCode: US
TelephoneNumber: 3103255111
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/08/2007
LastUpdateDate: 11/30/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XOPT5634CAY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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