Healthcare Provider Details

I. General information

NPI: 1538164322
Provider Name (Legal Business Name): CLIFTON SAUNDERS OTTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 ALA MOANA BLVD STE 500
HONOLULU HI
96815
US

IV. Provider business mailing address

PO BOX 1300 MAILCODE 61323
HONOLULU HI
96807-1300
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-0255
  • Fax: 808-955-4155
Mailing address:
  • Phone: 808-955-0255
  • Fax: 808-955-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD12486
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: