Healthcare Provider Details

I. General information

NPI: 1902948748
Provider Name (Legal Business Name): WESLIE MIYUKI HAMADA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CENTER ST STE 2
WAHIAWA HI
96786-2038
US

IV. Provider business mailing address

960 CENTER ST STE 2
WAHIAWA HI
96786-2038
US

V. Phone/Fax

Practice location:
  • Phone: 808-622-4121
  • Fax: 808-621-5041
Mailing address:
  • Phone: 808-622-4121
  • Fax: 808-621-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberHI 567
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: