Provider Demographics
NPI:1689822793
Name:ISHIKAWA, CHRISTINE CHIYEKO (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CHIYEKO
Last Name:ISHIKAWA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:CHIYEKO
Other - Last Name:ISHIKAWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:333 KEAHOLE ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3428
Mailing Address - Country:US
Mailing Address - Phone:808-395-6578
Mailing Address - Fax:
Practice Address - Street 1:333 KEAHOLE ST BLDG A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3428
Practice Address - Country:US
Practice Address - Phone:808-395-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIV06757Medicare UPIN
HI100846Medicare PIN