Provider Demographics
NPI:1275519811
Name:YAMAMOTO, DANIEL M (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
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 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:STE 1110
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4406
Mailing Address - Country:US
Mailing Address - Phone:808-949-2662
Mailing Address - Fax:808-947-0120
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:#1110
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4401
Practice Address - Country:US
Practice Address - Phone:808-949-2662
Practice Address - Fax:808-947-0120
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03083201Medicaid
HIT41317Medicare UPIN
HIH55262Medicare ID - Type UnspecifiedMEDICARE EDI
HI03083201Medicaid