MEDICARE: DR. HEATHER M WAWRZENSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12888	CA
2	152W00000X	Optometrist	OD635	HI

General Provider Information

NPI Number	:	1285755322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER M WAWRZENSKI O.D.

Provider Business Mailing Address
First Line	:	1000 KAMEHAMEHA HWY
Second Line	:	STE 100
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2596
Country	:	US
Telephone Number	:	808-388-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 KAMEHAMEHA HWY
Second Line	:	SUITE 100
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2881
Country	:	US
Telephone Number	:	808-456-3937
Fax Number	:	808-454-0683

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	10/05/2017

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