Provider Demographics
NPI:1538140264
Name:YOSHIMURA, LYMAN N (OD)
Entity Type:Individual
Prefix:
First Name:LYMAN
Middle Name:N
Last Name:YOSHIMURA
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 1:2964 EWALU ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1351
Mailing Address - Country:US
Mailing Address - Phone:808-245-2772
Mailing Address - Fax:808-245-4541
Practice Address - Street 1:2964 EWALU ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1351
Practice Address - Country:US
Practice Address - Phone:808-245-2772
Practice Address - Fax:808-245-4541
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 92152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI051248-01Medicaid
HI0000058610OtherHMSA
HI0865400001Medicare NSC
HI086540001Medicare ID - Type Unspecified
HIH0000PGBBKMedicare PIN
HI0000058610OtherHMSA