Healthcare Provider Details

I. General information

NPI: 1821083684
Provider Name (Legal Business Name): VERNON I SHIBATA O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST SUITE 610
HONOLULU HI
96814
US

IV. Provider business mailing address

1314 S KING ST SUITE 610
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-2991
  • Fax: 808-591-8267
Mailing address:
  • Phone: 808-591-2991
  • Fax: 808-591-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number132
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: