Individual provider Active NPI

Kyle Kiyoshi Harada, OD

  • Optometrist
  • Cupertino, CA
National Provider Identifier
1003420399
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2620 Issued in NC
Practice address
19998 Homestead Rd Ste E
Cupertino, CA 95014-0569
Phone
(408) 257-5262
Fax
(408) 257-8271
NPI assigned
Sep 3, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34666 CA
Optometrist 152W00000X 2620 NC Primary

Addresses

Primary practice location

19998 Homestead Rd Ste E
Cupertino, CA 95014-0569

Mailing address

19998 Homestead Rd Ste E
Cupertino, CA 95014-0569
Phone (408) 257-5262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201013000251 NC Practitioner - Optometry 1254751225 Reassigns benefits to 1 organization
I20231201000898 CA Practitioner - Optometry 1254751225 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2620NCMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Vision Studio, O.D., PLLC CurrentSince Sep 14, 2020 Accepting new patients
Keith Kosakura, O.D. PastSince Nov 17, 2023 Accepting new patients

Locations

570 New Waverly Pl
Ste 110
Cary, NC 27518
Phone (919) 770-3389

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1003420399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19998 HOMESTEAD RD STE E",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950140569",
            "telephone_number": "408-257-5262",
            "fax_number": "408-257-8271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19998 HOMESTEAD RD STE E",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950140569",
            "telephone_number": "408-257-5262",
            "fax_number": "408-257-8271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARADA",
        "first_name": "KYLE",
        "middle_name": "KIYOSHI",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-03",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34666",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cupertino, CA

Sources for this page

Verify at the official NPI Registry.