Provider Demographics
NPI:1154442697
Name:ROY Y. MATSUMOTO, O.D., INC.
Entity Type:Organization
Organization Name:ROY Y. MATSUMOTO, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MATSUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-671-6731
Mailing Address - Street 1:94-1030 WAIPIO UKA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4084
Mailing Address - Country:US
Mailing Address - Phone:808-671-6731
Mailing Address - Fax:808-676-5655
Practice Address - Street 1:94-1030 WAIPIO UKA ST STE 102
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4084
Practice Address - Country:US
Practice Address - Phone:808-671-6731
Practice Address - Fax:808-676-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIT41212Medicare UPIN
HIH52644Medicare ID - Type UnspecifiedMEDICARE NUMBER
HI4070300001Medicare NSC