MEDICARE: DR. PAULA HARUMI IMADA O.D., M.ED.

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	OD754	HI

General Provider Information

NPI Number	:	1669768552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA HARUMI IMADA O.D., M.ED.

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	:	808-292-3193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 KAMEHAMEHA HWY
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2881
Country	:	US
Telephone Number	:	808-454-0422
Fax Number	:

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	05/01/2017

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