Provider Demographics
NPI:1194863910
Name:YAMAMOTO, CHRIS KEIJI (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:KEIJI
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 N KING ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3470
Mailing Address - Country:US
Mailing Address - Phone:808-848-0527
Mailing Address - Fax:808-848-0528
Practice Address - Street 1:2024 N KING ST STE 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3470
Practice Address - Country:US
Practice Address - Phone:808-848-0527
Practice Address - Fax:808-848-0528
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04596801Medicaid
HI0414520001OtherMEDICARE DMERC
HIU13333Medicare UPIN
H0000PGBBFMedicare PIN
HI04596801Medicaid