Basic Information
| Provider Information | |||||||||
| NPI: | 1053835520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OTSUKA EYE CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 N KUAKINI ST STE 811 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172362 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 321 N KUAKINI ST STE 811 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085312731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2017 | ||||||||
| LastUpdateDate: | 07/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | OTSUKA | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8085312731 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.