Provider Demographics
NPI:1558698068
Name:AAFES OPTOMETRY (KADENA)
Entity Type:Organization
Organization Name:AAFES OPTOMETRY (KADENA)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIKIDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:01181098-959-2100
Mailing Address - Street 1:AAFES OPTOMETRY
Mailing Address - Street 2:OKINAWA EXCHANGE, UNIT 35163
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96378-5163
Mailing Address - Country:US
Mailing Address - Phone:001181098-959-2100
Mailing Address - Fax:01181098-959-2100
Practice Address - Street 1:3911 S WALTON WALKER BLVD
Practice Address - Street 2:FA-C/OR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75236-1509
Practice Address - Country:US
Practice Address - Phone:800-527-6790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154531861OtherDOCTOR'S INDIVIDUAL NPI