Provider Demographics
NPI:1659491272
Name:OKAMURA, ERYLE T (OD)
Entity Type:Individual
Prefix:DR
First Name:ERYLE
Middle Name:T
Last Name:OKAMURA
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 1:98-1247 KAAHUMANU ST STE 116
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5300
Mailing Address - Country:US
Mailing Address - Phone:808-484-1133
Mailing Address - Fax:
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 116
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-484-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01997501Medicaid
HIC2203-2OtherHMSA
HI01997501Medicaid