Provider Demographics
NPI:1407838162
Name:EDE, ROGER CHRISTIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHRISTIAN
Last Name:EDE
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 1:94-050 FARRINGTON HWY
Mailing Address - Street 2:STE B1-1
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1800
Mailing Address - Country:US
Mailing Address - Phone:808-677-1544
Mailing Address - Fax:808-671-3538
Practice Address - Street 1:377 KEAHOLE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3405
Practice Address - Country:US
Practice Address - Phone:808-396-6311
Practice Address - Fax:808-395-2448
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0406020005OtherMEDICARE SUPPLIER
HI0406020001OtherMEDICARE SUPPLIER
HI0406020002OtherMEDICARE SUPPLIER
HIH0000PGBBGMedicare PIN
HIH0000PGBHKMedicare PIN
HI0406020002OtherMEDICARE SUPPLIER
HIH0000PGBJXMedicare PIN