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General NPI Number Information
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NPI Number | 1013036128
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Entity Type | Organization
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Legal Business Name | MATSUYAMAS O D INC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 98-150 KAONOHI ST B211
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City | AIEA
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State | HI
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Zip | 96701-5047
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Country | US
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Telephone | 808-486-3937
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Fax | 808-486-3386
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Provider Business Mailing Address
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Address Line | 98-150 KAONOHI ST B211
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City | AIEA
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State | HI
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Zip | 96701-5047
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Country | US
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Telephone | 808-486-3937
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Fax | 808-486-3386
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAYNE SUSUMU MATSUYAMA
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Credential | O.D.
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Telephone | 808-486-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 130
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License Number State | HI
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