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General NPI Number Information
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NPI Number | 1164596979
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Entity Type | Individual
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Provider Name | DR. GERALD M MATSUDA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 30 AULIKE ST SUITE 102
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City | KAILUA
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State | HI
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Zip | 96734-2707
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Country | US
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Telephone | 808-262-8107
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Fax | 808-262-8108
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Provider Business Mailing Address
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Address Line | 30 AULIKE ST SUITE 102
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City | KAILUA
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State | HI
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Zip | 96734-2707
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Country | US
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Telephone | 808-262-8107
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Fax | 808-262-8108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 184
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License Number State | HI
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