Provider Demographics
NPI:1255491809
Name:TAKAMURA, LILLIAN H (OD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:H
Last Name:TAKAMURA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1927
Mailing Address - Country:US
Mailing Address - Phone:808-597-1133
Mailing Address - Fax:808-596-0251
Practice Address - Street 1:1003 PENSACOLA ST
Practice Address - Street 2:MINATOYA EYE CLINIC
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1927
Practice Address - Country:US
Practice Address - Phone:808-597-1133
Practice Address - Fax:808-596-0251
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 448152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIU77556Medicare UPIN
HIH55655Medicare PIN
HIH55655Medicare PIN