=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831318872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRIS K. YAMAMOTO OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 06/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2024 N KING ST SUITE 105
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-3470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-848-0527
-----------------------------------------------------
Fax | 808-848-0528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2024 N KING ST SUITE 105
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-3470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-848-0527
-----------------------------------------------------
Fax | 808-848-0528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRIS KEIJI YAMAMOTO
-----------------------------------------------------
Credential | O.D,
-----------------------------------------------------
Telephone | 808-848-0527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 150
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------