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NPI Code Detail

MEDICARE: DR. WALLACE M KOJIMA O.D.

MEDICARE: DR. WALLACE M KOJIMA O.D.
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
1152W00000XOptometrist250HI

General Provider Information

NPI Number : 1245336445
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WALLACE M KOJIMA O.D.
Provider Business Mailing Address
First Line : 73-5600 MAIAU ST
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-2630
Country : US
Telephone Number : 808-331-8081
Fax Number : 808-331-8082
Provider Business Practice Location Address
First Line : 73-5600 MAIAU ST
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-2630
Country : US
Telephone Number : 808-331-8081
Fax Number : 808-331-8082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 07/08/2007

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