Provider Demographics
NPI:1437250826
Name:MATSUMOTO, ROY YASUO (OD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:YASUO
Last Name:MATSUMOTO
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 1:94-1030 WAIPIO UKA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4084
Mailing Address - Country:US
Mailing Address - Phone:808-671-6731
Mailing Address - Fax:808-676-5655
Practice Address - Street 1:94-1030 WAIPIO UKA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4084
Practice Address - Country:US
Practice Address - Phone:808-671-6731
Practice Address - Fax:808-676-5655
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIT41212Medicare UPIN
HIH52644Medicare ID - Type UnspecifiedMEDICARE NUMBER