MEDICARE: RICHARD H. MIYASAKA OD LLC

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

General Provider Information

NPI Number	:	1912530395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD H. MIYASAKA OD LLC

Provider Business Mailing Address
First Line	:	PO BOX 29690
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96820-2090
Country	:	US
Telephone Number	:	808-677-7727
Fax Number	:	808-697-5488

Provider Business Practice Location Address
First Line	:	3615 HARDING AVE STE 208
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3760
Country	:	US
Telephone Number	:	808-734-8870
Fax Number	:	808-737-2307

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	RICHARD MIYASAKA
Credential	:	OD
Telephone Number	:	808-734-8870

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	06/06/2020

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