MEDICARE: GRANT Y. FUSATO, OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD516	HI

General Provider Information

NPI Number	:	1235645615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANT Y. FUSATO, OD

Provider Business Mailing Address
First Line	:	4510 SALT LAKE BLVD STE B11
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3171
Country	:	US
Telephone Number	:	808-486-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 SALT LAKE BLVD STE B11
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3171
Country	:	US
Telephone Number	:	808-486-9393
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GRANT FUSATO
Credential	:	OD
Telephone Number	:	808-486-9393

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	12/20/2017

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