Provider Demographics
NPI:1013036128
Name:MATSUYAMAS O D INC
Entity Type:Organization
Organization Name:MATSUYAMAS O D INC
Other - Org Name:STYLEYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:SUSUMU
Authorized Official - Last Name:MATSUYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-486-3937
Mailing Address - Street 1:98-150 KAONOHI ST
Mailing Address - Street 2:B211
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5047
Mailing Address - Country:US
Mailing Address - Phone:808-486-3937
Mailing Address - Fax:808-486-3386
Practice Address - Street 1:98-150 KAONOHI ST
Practice Address - Street 2:B211
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5047
Practice Address - Country:US
Practice Address - Phone:808-486-3937
Practice Address - Fax:808-486-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05156700Medicaid
HIB5892-1OtherHMSA
HIHI90130OtherVISION BENEFITS
HI00B0058921Medicaid
HI576602066OtherVISION SERVICE PLAN
HI05156701Medicaid
HI193775OtherSUMMERLIN
HIOP0579OtherEYEMED
HI193775OtherHMA
HI57660206621OtherUNIVERSITY HEALTH ALLIANC
HI576602066264OtherUNIVERSITY HEALTH ALLIANC
HI00B0058921Medicaid
HIB5892-1OtherHMSA
HIT41215Medicare UPIN