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General NPI Number Information
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NPI Number | 1417904798
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Entity Type | Individual
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Provider Name | IRA M FUJISAKI O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 850 KAM HWY 166
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City | PEARL CITY
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State | HI
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Zip | 96782-2656
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Country | US
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Telephone | 808-455-1922
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Fax | 808-455-1811
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Provider Business Mailing Address
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Address Line | 850 KAM HWY 166
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City | PEARL CITY
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State | HI
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Zip | 96782-2656
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Country | US
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Telephone | 808-455-1922
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Fax | 808-455-1811
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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 | 245
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License Number State | HI
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