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General NPI Number Information
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NPI Number | 1750707212
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Entity Type | Organization
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Legal Business Name | DR.KATHY IIDA, OPTOMETRIST INC.
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 46-056 KAMEHAMEHA HWY STE 277
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City | KANEOHE
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State | HI
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Zip | 96744-6708
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Country | US
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Telephone | 808-236-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 46-056 KAMEHAMEHA HWY STE 277
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City | KANEOHE
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State | HI
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Zip | 96744-6708
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Country | US
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Telephone | 808-236-2666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHY IIDA
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Credential |
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Telephone | 808-256-6780
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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 | 587
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License Number State | HI
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