Healthcare Provider Details

I. General information

NPI: 1558698068
Provider Name (Legal Business Name): AAFES OPTOMETRY (KADENA)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 S WALTON WALKER BLVD FA-C/OR
DALLAS TX
75236-1509
US

IV. Provider business mailing address

AAFES OPTOMETRY OKINAWA EXCHANGE, UNIT 35163
APO AP
96378-5163
US

V. Phone/Fax

Practice location:
  • Phone: 800-527-6790
  • Fax:
Mailing address:
  • Phone: 0011810989592100
  • Fax: 011810989592100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GLEN HIKIDA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 011810989592100