Provider Demographics
NPI:1881581908
Name:SUGIMOTO, JOANNA MICHIKO (OD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MICHIKO
Last Name:SUGIMOTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2221
Mailing Address - Country:US
Mailing Address - Phone:510-833-0426
Mailing Address - Fax:
Practice Address - Street 1:958 MORAGA RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4525
Practice Address - Country:US
Practice Address - Phone:925-283-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist