Provider Demographics
NPI:1538464011
Name:EDWIN YOSHIO ENDO
Entity Type:Organization
Organization Name:EDWIN YOSHIO ENDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ENDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-487-5500
Mailing Address - Street 1:98-1247 KAAHUMANU ST
Mailing Address - Street 2:STE 105
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5300
Mailing Address - Country:US
Mailing Address - Phone:808-487-5500
Mailing Address - Fax:
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:STE 105
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-487-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04604501Medicaid
HIHEENDOOtherMEDICARE GROUP
HIHEENDOOtherMEDICARE GROUP
HI04604501Medicaid
HI0492220001Medicare NSC