Provider Demographics
NPI:1033518493
Name:LEEWARD EYE CARE, INC
Entity Type:Organization
Organization Name:LEEWARD EYE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FUJISAKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-455-1922
Mailing Address - Street 1:850 KAMEHAMEHA HWY
Mailing Address - Street 2:166
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2656
Mailing Address - Country:US
Mailing Address - Phone:808-455-1922
Mailing Address - Fax:808-455-1807
Practice Address - Street 1:850 KAMEHAMEHA HWY
Practice Address - Street 2:166
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2657
Practice Address - Country:US
Practice Address - Phone:808-455-1922
Practice Address - Fax:808-455-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1164542320Medicaid
HI1164542320Medicaid