| Doctor Name: | FORD SCOTT TAKAICHI |
| NPI Number: | 1093055238 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ABO |
| License Number: | 183993 |
| Business Practice Address: | 3555 Clares St Suite H Capitola, CA - 950102555 |
| Business Phone Number: | 8314774900 |
| Business Fax Number: | 8314774909 |
| Mailing Address: | 3555 Clares St, Suite H CAPITOLA |
| State: | CA |
| Postal Code: | 950102555 |
| Phone Number: | 8314774900 |
| Fax Number: | 8314774909 |
| NPI Enumeration Date: | 02/25/2013 |
| NPI Last Update Date: | 02/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 183993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |