MEDICARE: AAFES OPTOMETRY (KADENA)

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	261QM2500X	Medical Specialty Clinic/Center		ZZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1154531861	OTHER		DOCTOR'S INDIVIDUAL NPI

General Provider Information

NPI Number	:	1558698068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAFES OPTOMETRY (KADENA)

Provider Business Mailing Address
First Line	:	AAFES OPTOMETRY
Second Line	:	OKINAWA EXCHANGE, UNIT 35163
City	:	APO
State	:	AP
Zip	:	96378-5163
Country	:	US
Telephone Number	:	0011810989592100
Fax Number	:	011810989592100

Provider Business Practice Location Address
First Line	:	3911 S WALTON WALKER BLVD
Second Line	:	FA-C/OR
City	:	DALLAS
State	:	TX
Zip	:	75236-1509
Country	:	US
Telephone Number	:	800-527-6790
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. GLEN HIKIDA
Credential	:	OD
Telephone Number	:	011810989592100

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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