Provider Demographics
NPI:1255497475
Name:MASAKI, MELANIE J (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:J
Last Name:MASAKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:91-2139 FT WEAVER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-677-2733
Mailing Address - Fax:808-441-7737
Practice Address - Street 1:91-2139 FT WEAVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-677-2733
Practice Address - Fax:808-441-7737
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI505612Medicaid
HI52493Medicare ID - Type Unspecified
HIB5228-8Medicare UPIN
HI990236358Medicare UPIN
HI505612Medicaid