Ricardo Fukuzato, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002431 Issued in GA

Practice address

11720 Medlock Bridge Rd
Suite 140
Johns Creek, GA 30097-1509

Phone

(770) 495-7898

NPI assigned

Mar 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ga Doctors of Optometry LLC

  • Optometrist
  • Lithonia, GA
  • NPI 1174105936

  GA, Optometrist

  Medicare reassignment NPD
• Mark Lynn OD & Associates, PC

  • Optometrist
  • Lithonia, GA
  • NPI 1417055203

  GA, Optometrist

  Medicare reassignment NPD
• Ga Doctors of Optometry LLC

  • Eyewear Supplier
  • Columbus, GA
  • NPI 1013599745

  Optometrist

  NPD
• Mark Lynn O.D. & Associates, PC

  • Eyewear Supplier
  • Savannah, GA
  • NPI 1518375500
  NPD

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231718400000",
    "number": "1013045368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131338",
            "telephone_number": "812-285-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 MEDLOCK BRIDGE RD",
            "address_2": "SUITE 140",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971509",
            "telephone_number": "770-495-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUKUZATO",
        "first_name": "RICARDO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2009-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12991T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fourth Wall Testing LLC
• Constance Francis-Agalaba
• Macy Ellen Frazier, OD
• Emily French, PT, DPT
• Tais Frozi Antunes
• Jin Gao, RPH
• Henry Lawrence Gardiner III, MD
• Stephanie Stein Gardner, MD
• Eli Christopher Garrard, M.D.
• William Cody Garren

• All providers in Johns Creek, GA
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.