Provider Demographics
NPI:1184676264
Name:ABE, DERRICK KAZUHISA (OD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:KAZUHISA
Last Name:ABE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE # 805
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4401
Mailing Address - Country:US
Mailing Address - Phone:808-946-6136
Mailing Address - Fax:808-943-6236
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE # 805
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4401
Practice Address - Country:US
Practice Address - Phone:808-946-6136
Practice Address - Fax:808-943-6236
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04560501Medicaid
HIU52191Medicare UPIN
HI04560501Medicaid