Provider Demographics
NPI:1639280696
Name:TERUYA, BRIAN MASAICHI (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MASAICHI
Last Name:TERUYA
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 1:3221 WAIALAE AVE
Mailing Address - Street 2:#340
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5842
Mailing Address - Country:US
Mailing Address - Phone:808-734-4343
Mailing Address - Fax:808-734-3930
Practice Address - Street 1:3221 WAIALAE AVE
Practice Address - Street 2:#340
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5842
Practice Address - Country:US
Practice Address - Phone:808-734-4343
Practice Address - Fax:808-734-3930
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000PGBBZMedicare ID - Type Unspecified