Healthcare Provider Details

I. General information

NPI: 1053835520
Provider Name (Legal Business Name): OTSUKA EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 811
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

321 N KUAKINI ST STE 811
HONOLULU HI
96817-2362
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN OTSUKA
Title or Position: OWNER
Credential: MD
Phone: 808-531-2731