Provider Demographics
NPI:1508980095
Name:YVETTE NS HIDA OD INC
Entity Type:Organization
Organization Name:YVETTE NS HIDA OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:NS
Authorized Official - Last Name:HIDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-622-2020
Mailing Address - Street 1:610 KILANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1904
Mailing Address - Country:US
Mailing Address - Phone:808-622-2020
Mailing Address - Fax:808-622-9009
Practice Address - Street 1:610 KILANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1904
Practice Address - Country:US
Practice Address - Phone:808-622-2020
Practice Address - Fax:808-622-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI336152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102566OtherLEGACY PROVIDER # / PTAN
HI07120203Medicaid
HI07120203Medicaid
HIH50639Medicare PIN