Provider Demographics
NPI:1417904798
Name:FUJISAKI, IRA M (OD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:FUJISAKI
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 1:850 KAM HWY
Mailing Address - Street 2:166
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2656
Mailing Address - Country:US
Mailing Address - Phone:808-455-1922
Mailing Address - Fax:808-455-1811
Practice Address - Street 1:850 KAM HWY
Practice Address - Street 2:166
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2656
Practice Address - Country:US
Practice Address - Phone:808-455-1922
Practice Address - Fax:808-455-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00E0025949OtherHMSA QUEST
HIE2594-9Other65 C PLUS
HI245OtherUHA
HIE2594-9OtherHMSA
HI02339601Medicaid
HI245OtherUHA
HIH0000PGBFKMedicare PIN
HI0000PGBMLMedicare ID - Type UnspecifiedEXAMINATION ONLY