MEDICARE: EYEWEAR HAWAII, INC.

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	156FX1800X	Optician	DIO38	HI

General Provider Information

NPI Number	:	1619033768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEWEAR HAWAII, INC.

Provider Business Mailing Address
First Line	:	99-1253 HALAWA VALLEY ST
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3281
Country	:	US
Telephone Number	:	808-486-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	99-1253 HALAWA VALLEY ST
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3281
Country	:	US
Telephone Number	:	808-486-2933
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GLENN SHIGEMURA
Credential	:
Telephone Number	:	808-486-2933

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	08/22/2020

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