Provider Demographics
NPI:1114563582
Name:AU, WALTER GWOK WO (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:GWOK WO
Last Name:AU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 PALOLO AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2579
Mailing Address - Country:US
Mailing Address - Phone:808-218-2390
Mailing Address - Fax:
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 105
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-487-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist