Active NPI
Clifford A Fukushima, O.D.
- Optometrist
- Visalia, CA
National Provider Identifier
1093929085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT6441T
- Practice address
- 5501 W Hillsdale Ave Ste D
Visalia, CA 93291-5159 - Phone
- (559) 625-5464
- Fax
- (559) 625-0714
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT6441T | CA | Primary |
Addresses
Primary practice location
5501 W Hillsdale Ave Ste D
Visalia, CA 93291-5159
Mailing address
5501 W Hillsdale Ave Ste D
Visalia, CA 93291-5159
Phone (559) 625-5464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0064410 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 3, 2022 through Jan 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT6441T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1093929085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5501 W HILLSDALE AVE STE D",
"city": "VISALIA",
"state": "CA",
"postal_code": "932915159",
"telephone_number": "559-625-5464",
"fax_number": "559-625-0714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 W HILLSDALE AVE STE D",
"city": "VISALIA",
"state": "CA",
"postal_code": "932915159",
"telephone_number": "559-625-5464",
"fax_number": "559-625-0714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUKUSHIMA",
"first_name": "CLIFFORD",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT6441T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0064410",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Visalia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.