MEDICARE: DR. CHERYL C. NIITANI O.D.

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	OD-311	HI
2	152W00000X	Optometrist	OD-219	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J2151-7	OTHER	HI	HMSA
2	57674230121	OTHER	HI	UNITED HEALTH ALLIANCE
3	J7767-5	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1922134105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL C. NIITANI O.D.

Provider Business Mailing Address
First Line	:	850 KAMEHAMEHA HWY
Second Line	:	SUITE 114
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2656
Country	:	US
Telephone Number	:	808-455-3333
Fax Number	:	808-455-5074

Provider Business Practice Location Address
First Line	:	850 KAMEHAMEHA HWY
Second Line	:	SUITE 114
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2656
Country	:	US
Telephone Number	:	808-455-3333
Fax Number	:	808-455-5074

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

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. CHERYL C. NIITANI O.D.” Practice Location

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