Provider Demographics
NPI:1528224367
Name:WINDWARD VISION CENTER ASSOCIATES, INC
Entity Type:Organization
Organization Name:WINDWARD VISION CENTER ASSOCIATES, INC
Other - Org Name:DRS MATSUDA AND MACHIDA OPTOMETRIST INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHANG MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-262-8107
Mailing Address - Street 1:30 AULIKE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2739
Mailing Address - Country:US
Mailing Address - Phone:808-262-8107
Mailing Address - Fax:808-262-8108
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2739
Practice Address - Country:US
Practice Address - Phone:808-262-8107
Practice Address - Fax:808-262-8108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDWARD VISION CENTER ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-31
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBY562BMedicare PIN
HI0824380001Medicare NSC