Basic Information
| Provider Information | |||||||||
| NPI: | 1750555132 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROGER CHRISTIAN EDE, O.D., INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VISION CARE CENTERS OF HAWAII | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86-120 FARRINGTON HWY | ||||||||
| Address2: | SUITE C301 | ||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967021 | ||||||||
| FaxNumber: | 8086963075 | ||||||||
| Practice Location | |||||||||
| Address1: | 86-120 FARRINGTON HWY | ||||||||
| Address2: | SUITE C301 | ||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967021 | ||||||||
| FaxNumber: | 8086963075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EDE | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8086967021 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROGER CHRISTIAN EDE, O.D., INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 103 | HI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.