Provider Demographics
NPI:1225005325
Name:GRANT T MIYASHIRO OD LLC
Entity Type:Organization
Organization Name:GRANT T MIYASHIRO OD LLC
Other - Org Name:EYE CARE HAWAII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:TADASHI
Authorized Official - Last Name:MIYASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-935-8887
Mailing Address - Street 1:34 W. KAWAILANI ST.
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-935-8887
Mailing Address - Fax:888-892-5882
Practice Address - Street 1:34 W. KAWAILANI ST.
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-8887
Practice Address - Fax:888-892-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIOOA0223063OtherHMSA
HIU72340Medicare UPIN
HIH56770Medicare PIN
HIOOA0223063OtherHMSA