Provider Demographics
NPI:1790770113
Name:FUJIMOTO, DAVID K (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:FUJIMOTO
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 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 419
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4401
Mailing Address - Country:US
Mailing Address - Phone:808-949-2902
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 419
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4401
Practice Address - Country:US
Practice Address - Phone:808-949-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI068287Medicaid
HIH52384Medicare PIN
HI068287Medicaid
HIU28782Medicare UPIN