MEDICARE: CLIFTON SAUNDERS OTTO MD

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	207W00000X	Ophthalmology Physician	MD12486	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538164322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON SAUNDERS OTTO MD

Provider Business Mailing Address
First Line	:	PO BOX 1300
Second Line	:	MAILCODE 61323
City	:	HONOLULU
State	:	HI
Zip	:	96807-1300
Country	:	US
Telephone Number	:	808-955-0255
Fax Number	:	808-955-4155

Provider Business Practice Location Address
First Line	:	1620 ALA MOANA BLVD
Second Line	:	STE 500
City	:	HONOLULU
State	:	HI
Zip	:	96815
Country	:	US
Telephone Number	:	808-955-0255
Fax Number	:	808-955-4155

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/14/2014

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