=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952640476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALVIN M. MIURA, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2013
-----------------------------------------------------
Last Update Date | 02/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 SOUTH KING STREET SUITE 1001
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-947-2233
-----------------------------------------------------
Fax | 808-944-0930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 SOUTH KING STREET SUITE 1001
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-947-2233
-----------------------------------------------------
Fax | 808-944-0930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CALVIN MASARU MIURA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-947-2233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD2077
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------