Provider Demographics
NPI:1073638839
Name:TSUE, JOHN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:TSUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:75-5722 KUAKINI HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-329-5253
Mailing Address - Fax:808-326-4765
Practice Address - Street 1:755722 KUAKINI HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-329-5253
Practice Address - Fax:808-326-4765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI138D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04287701Medicaid
T41304Medicare UPIN
HI0000PCBNPMedicare ID - Type Unspecified
HI04287701Medicaid