=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487851150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNE K. MATSUSHIMA, O.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3615 HARDING AVE STE 208
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-3760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-734-8870
-----------------------------------------------------
Fax | 808-737-2307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3615 HARDING AVE STE 208
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-3760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-734-8870
-----------------------------------------------------
Fax | 808-737-2307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANNE K MATSUSHIMA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 808-734-8870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 162
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------